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1.
Pan Afr Med J ; 37: 389, 2020.
Article in English | MEDLINE | ID: covidwho-1168164

ABSTRACT

Introduction: as COVID-19 pandemic is rapidly evolving, there is a whole reorganization in hospitals to concentrate more resources to face the crisis. The purpose of this study is to evaluate the impact of COVID-19 disease on urological activity in Tunisia. To assess the differences in the management of urological conditions between the private and the public field. Methods: a survey was addressed to all certified urologists working in Tunisia in both the public and private sectors (n=194) using the national database of active urologists available and updated. We either called them or looked them up through email or social media. The form was open from March the 28th to April the 3rd. Results were obtained via spreadsheet and analysed using SPSS 23.0. Results: one hundred and twenty urologists have filled in the form. Consultations at the outpatient office were restricted to urgent cases in 66% (n=79). Telemedicine was more used by urologists in private than in public fields p=0.03. Urologists in private sector followed more the sterilization protocol of the hospital/clinic and used more disposable materials whenever possible p=0.011. Elective surgical activity has completely stopped in 85% of the responders (n=102). Elective surgery requiring transfusion or intensive care unit was performed in 38% (n=46) and 26% (n=31) if there was a risk of disease progression. Benign Prostate Hyperplasia (BPH) surgery was more performed as usual in private sector than in public sector p=0.012. It was the only condition managed differently between both sectors. Conclusion: the drop of the urological activity is essential in order to give relevant stakeholders room to act efficiently against the spread of the virus. The context of the pandemic and the hospital´s condition must be taken into consideration without compromising the patient´s outcome.


Subject(s)
Urologic Diseases/therapy , Urologic Surgical Procedures/statistics & numerical data , Urologists/statistics & numerical data , Adult , Elective Surgical Procedures/statistics & numerical data , Humans , Male , Middle Aged , Private Sector/statistics & numerical data , Prostatic Hyperplasia/surgery , Public Sector/statistics & numerical data , Surveys and Questionnaires , Telemedicine/statistics & numerical data , Tunisia , Urologic Diseases/physiopathology
2.
Cir Cir ; 89(2): 183-188, 2021.
Article in English | MEDLINE | ID: covidwho-1158504

ABSTRACT

ANTECEDENTES: La pandemia de COVID-19 ha ocasionado que los servicios de cirugía y de salud en todo el mundo tengan que reorganizarse y planear para poder brindar la mejor atención a los pacientes, con la protección necesaria para el personal de salud. Algunos de estos pacientes requerirán tratamiento quirúrgico, ya sea electivo o de urgencia. OBJETIVO: Reportar la experiencia inicial en el manejo de pacientes con COVID-19 que ameritaron tratamiento quirúrgico por los servicios de cirugía de un hospital de referencia. MÉTODO: Revisión de los protocolos quirúrgicos, equipo de protección personal usado por los equipos quirúrgicos y resultados del tratamiento de 42 pacientes sometidos a cirugía en un periodo de 4 meses. RESULTADOS: Fueron intervenidos 42 pacientes con COVID-19. Treinta pacientes tenían diagnóstico de infección por SARS-CoV-2 y en 12 casos el diagnóstico fue clínico y por imagen. Las cirugías más frecuentes fueron traqueostomía en 16 pacientes (38%) y laparotomías exploradoras en 8 pacientes (19%). La mediana de estancia posoperatoria fue de 17 días y la mortalidad durante los primeros 30 días fue del 26%. CONCLUSIONES: Es necesaria la reorganización de los departamentos quirúrgicos y del hospital para poder atender adecuadamente a los pacientes con COVID-19 y proteger al personal de salud. Los pacientes pueden presentan patologías que requieran tratamiento quirúrgico. Relacionado con la infección y la mayor frecuencia de comorbilidad, la mortalidad de estos pacientes es elevada. INTRODUCTION: the COVID-19 pandemic has caused a reorganization of hospital and general surgery departments worldwide to assure the best medical and surgical treatment of patients with this disease and protection of the health-related personnel. Some of them will require surgical treatment either elective or urgent. OBJECTIVE: report the initial experience in the management of patients with COVID-19 in a third level hospital. MATERIAL AND METHODS: a review of the surgical protocols, personal protection equipment used by the surgical teams, and results of the treatment of forty-two patients submitted to surgery. RESULTS: During four months (April-July 2020) forty-two patients with suspicion or confirmed infection of SARS-CoV2 underwent surgical treatment. The most common surgery was tracheostomy in 16 patients (38%) followed by exploratory laparotomy in 8 patients (19%). The median postoperative stay was 17 days and the thirty-day postoperative mortality rate was 26%. CONCLUSIONS: reorganization of the general surgery department and the hospital, favors adequate management and treatment of patients with COVID-19 and protection to the health-related personnel. Due to the usual co-existence of comorbidities and pulmonary complications the postoperative mortality of these patients is high.


Subject(s)
/epidemiology , Laparotomy/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Tracheostomy/statistics & numerical data , /diagnosis , /surgery , Comorbidity , Elective Surgical Procedures/statistics & numerical data , Emergencies/epidemiology , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Personal Protective Equipment , Surgical Procedures, Operative/methods , Time Factors
4.
BJS Open ; 5(2)2021 03 05.
Article in English | MEDLINE | ID: covidwho-1127312

ABSTRACT

BACKGROUND: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. METHODS: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). RESULTS: Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7-12, this decreased to 9.2-13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. CONCLUSION: This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , Family Leave/statistics & numerical data , Health Workforce , Quarantine/statistics & numerical data , Sick Leave/statistics & numerical data , Surgeons/supply & distribution , Surgery Department, Hospital , Cross-Sectional Studies , Humans , Internationality
5.
Updates Surg ; 73(2): 731-744, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1114327

ABSTRACT

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020). RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.


Subject(s)
/epidemiology , Elective Surgical Procedures/statistics & numerical data , Infection Control/standards , Laparoscopy/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Humans , Italy/epidemiology , Pandemics , Surveys and Questionnaires
6.
Acta Biomed ; 91(4): e2020152, 2020 11 10.
Article in English | MEDLINE | ID: covidwho-1106691

ABSTRACT

Objective Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in a General Surgery Unit of a tertiary Covid-Hospital.   Methods We report and compared all the surgical procedures performed between two periods (March and April 2019 and March and April 2020) at General Surgery Department of Parma University Hospital, a tertiary Covid-Hospital.   Results Between March and April 2019, a total of 232 surgical procedures were performed. Between March and April 2020 only 61 surgical procedures were performed. In 2019 84 patients underwent surgery for cancer and 171 underwent surgery for benign diseases. In 2020 only 37 patients underwent surgery for oncological reasons and 24 underwent surgery for benign diseases.   Conclusions During pandemic Covid-19 the access to health services was limited and poor. Limited access to health services and the fear of Covid-19 infection can explain the lower number of elective surgical procedures for cancer in 2020 compared to the same period in the 2019.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , General Surgery , Humans , Italy , Surgery Department, Hospital , Tertiary Care Centers , Time Factors
10.
Br J Surg ; 108(1): 97-103, 2021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1104800

ABSTRACT

BACKGROUND: The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled. METHODS: This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals. RESULTS: A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million. CONCLUSION: As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.


Subject(s)
/epidemiology , Elective Surgical Procedures/economics , Elective Surgical Procedures/statistics & numerical data , Hospital Costs , Pandemics , /diagnosis , England/epidemiology , Facilities and Services Utilization/economics , Hospitalization/statistics & numerical data , Humans , Models, Statistical , Personal Protective Equipment , Preoperative Care , Time-to-Treatment/economics
11.
Ulus Travma Acil Cerrahi Derg ; 27(2): 180-186, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1102680

ABSTRACT

BACKGROUND: This article aims to give practical information and concrete suggestions on what should be considered in emergency, semi-urgent and elective settings for common anorectal diseases in the hectic period of the COVID-19 pandemic, based on early results of a series of anorectal interventions. METHODS: Referring to other related guidelines, general considerations specific to the diagnosis and treatment of highly prevalent anorectal diseases were developed to target the correct patients, evaluate and orientate by telemedicine, adapt the Proctology Unit to the new pandemic, and control contamination and infection. Specific considerations for common anorectal diseases were cited, and our initial results were retrospectively documented. RESULTS: From March 1 to April 10, 2020, we contacted 240 patients with anorectal diseases in two centers. We evaluated the results retrospectively on 16-17 April. At the end of this survey, 14 patients (5.8%) were lost for further contact and follow-up. Thirty-one patients (12.9%) were evaluated as nondeferrable cases and invited to the Proctology Unit. Twenty-eight patients required interventions at the same session. Adhering to the principles described here, more than 90 percent of benign anorectal disorders could be treated successfully, with 2.1 percent of suspected contamination and no confirmed cases. None of the Proctology personnel or their close contacts developed COVID-19, either. CONCLUSION: By adhering to the principles outlined in this practical guide, it was possible to treat most of the benign anorectal diseases safely in the initial, hectic period of the COVID-19 pandemic.


Subject(s)
Colorectal Surgery , Guideline Adherence , Pandemics , Practice Guidelines as Topic , Practice Patterns, Physicians' , Colorectal Neoplasms/surgery , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Humans , Male , Prostatic Neoplasms/surgery , Spain
12.
Ann Ital Chir ; 91: 563-567, 2020.
Article in English | MEDLINE | ID: covidwho-1068445

ABSTRACT

2019-nCoV currently named SARS-CoV-2 is a highly pathogenic Coronavirus identified in Wuhan China in December 2019. Turkey declared the first case relatively late compared to Asian and European countries on March 11, as the first SARS-CoV-2 infection in Turkey. In this study, we aimed to determine patients' outcomes in 50 surgeries done in the incubation period of SARS-CoV-2 in our hospital. METHODS: We retrospectively analyzed the clinical data of 50 patients who underwent surgeries during the incubation period of CoVid-19 at Istinye University Gaziosmanpasa Medical Park Hospital in Istanbul, from March 2 to April 11, 2020. RESULTS: The age of 50 patients range was 21 to 73, and the median age was 43.32 (64%) patients were women. The median length of hospital stay is 2.6 days (1-21). Operations at various difficulty levels were also performed on patients with co-morbidities. No complication or mortality was observed except for 1 patient, and the ICU requirement of that patient was also due to high energy trauma. CONCLUSION: Although contrary claims have been made in various studies; it is the primary duty of us surgeons to operate CoVid-19 positive/suspicious patients safely and without any contamination, and on the other hand, to continue their operations without victimizing negative patients. In this pilot study, we would like to emphasize with necessary and adequate measures these can be achieved. KEY WORDS: CoVid-19, SARS-CoV-2, Surgery.


Subject(s)
/diagnosis , Emergencies/epidemiology , Hospitals, Isolation/statistics & numerical data , Hospitals, University/statistics & numerical data , Infectious Disease Incubation Period , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Surgical Procedures, Operative/statistics & numerical data , Adult , Aged , /epidemiology , Comorbidity , Elective Surgical Procedures/mortality , Elective Surgical Procedures/statistics & numerical data , Equipment Contamination/prevention & control , Female , Hospital Mortality , Humans , Infection Control/methods , Male , Middle Aged , Patient Isolation , Pilot Projects , Retrospective Studies , Surgical Procedures, Operative/mortality , Tomography, X-Ray Computed , Turkey/epidemiology , Young Adult
13.
Orthopedics ; 43(6): 351-355, 2020 Nov 01.
Article in English | MEDLINE | ID: covidwho-1067820

ABSTRACT

This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [Orthopedics. 2020;43(6):351-355.].


Subject(s)
Coronavirus Infections/epidemiology , Orthopedic Procedures/statistics & numerical data , Orthopedic Surgeons , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians' , Betacoronavirus , Elective Surgical Procedures/statistics & numerical data , Facilities and Services Utilization , Female , Health Care Surveys , Hospital Administration , Humans , Income , Louisiana/epidemiology , Male , Orthopedic Surgeons/economics , Pandemics , Remote Consultation
14.
J Perioper Pract ; 31(3): 62-70, 2021 03.
Article in English | MEDLINE | ID: covidwho-1067156

ABSTRACT

BACKGROUND: The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as 'COVID-cold' operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. METHOD: Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. RESULTS: The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age (p = 0.004), BMI (p = 0.01), ASA Score (p = 0.006), previous ERCP (p = 0.05), imaging suggesting cholecystitis (p = 0.003) and thick-walled gallbladder (p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05-3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72-11.38; p = 0.002) and previous ERCP (5.25, 1.53-18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35-39.9kg/m2. CONCLUSIONS: Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35-39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.


Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Cholecystectomy, Laparoscopic/statistics & numerical data , Adult , Cholecystitis/surgery , Elective Surgical Procedures/statistics & numerical data , Female , Gallbladder/surgery , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Wales
15.
Jt Dis Relat Surg ; 32(1): 3-9, 2021.
Article in English | MEDLINE | ID: covidwho-1067912

ABSTRACT

OBJECTIVES: This study aims to investigate the effectiveness of a screening questionnaire to identify high-risk patients for novel coronavirus-2019 (COVID-19) among those undergoing elective orthopedic surgery. PATIENTS AND METHODS: Between May 4th, 2020 and June 11th, 2020, a total of 1,021 consecutive patients (492 males, 529 females; mean age: 62.3±15.1 years; range, 13 to 91 years) who were scheduled for elective orthopedic surgery were included. A screening questionnaire was applied to all patients. The patients admitted to hospital were also tested for COVID-19 infection through reverse transcription-polymerase chain reaction of the nasopharyngeal swab. RESULTS: Of the patients, 1,003 (98.2%) underwent elective surgery as planned. The screening questionnaire classified 30 patients as high-risk for COVID-19. A total of 18 procedures (n=18, 1.8%) were postponed due to the high risk of possible transmission of COVID-19. None of 991 low-risk patients were tested positive for COVID-19. CONCLUSION: The use of guiding principles for resuming elective orthopedic surgery is safe without a higher risk for complications in selected cases.


Subject(s)
Arthroplasty/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Hospitalization , Adolescent , Adult , Aged , Aged, 80 and over , Disease Transmission, Infectious/prevention & control , Female , Germany/epidemiology , Hospitals, High-Volume , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Risk Assessment , Surveys and Questionnaires , Young Adult
16.
BMJ Open ; 10(10): e042392, 2020 10 31.
Article in English | MEDLINE | ID: covidwho-1060115

ABSTRACT

OBJECTIVES: The suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers. DESIGN: Retrospective observational study using Hospital Episode Statistics. SETTING: Public and private hospitals providing surgical care to National Health Service (NHS) patients in England. PARTICIPANTS: All adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURES: The identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data. RESULTS: A total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved 'low risk' patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities. CONCLUSIONS: Pooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , Markov Chains , Models, Organizational , Pandemics , State Medicine/organization & administration , Waiting Lists , Adult , Betacoronavirus , Community Networks/organization & administration , Coronavirus Infections/epidemiology , Efficiency, Organizational , Elective Surgical Procedures/classification , England/epidemiology , Health Services Accessibility , Humans , Intersectoral Collaboration , Pneumonia, Viral/epidemiology , Retrospective Studies , Risk Assessment , State Medicine/statistics & numerical data
17.
Int J Qual Health Care ; 33(1)2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1045855

ABSTRACT

BACKGROUND: Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient's health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient's cost utility due to delayed elective cholecystectomy. METHODS: This study is based on retrospective analysis of a longitudinal sample of participants who have had elective cholecystectomy and completed the EQ-5D(3L) measuring health status preoperatively and postoperatively. Emergent cases were excluded. Patients younger than 19 years of age, unable to communicate in English or residing in a long-term care facility were ineligible. Quality-adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and postoperative time points. The loss in quality-adjusted life years due to delayed access was calculated under four assumed scenarios regarding the length of the delay. The mean cost per quality-adjusted life years are shown for the overall sample and by sex and age categories. RESULTS: Among the 646 eligible patients, 30.1% of participants (N = 195) completed their preoperative and postoperative EQ-5D(3L). A delay of 12 months resulted in a mean loss of 6.4%, or 0.117, of the quality-adjusted life years expected without the delay. Among patients older than 70 years of age, a 12-month delay in their surgery corresponded with a 25.1% increase in the cost per quality-adjusted life years, from $10 758 to $13 463. CONCLUSIONS: There is a need to focus on minimizing loss of quality of life for patients affected by delayed surgeries. Faced with equal delayed access to elective surgery, triage may need to prioritize older patients to maximize their health over their remaining life years.


Subject(s)
/epidemiology , Cholecystectomy/psychology , Elective Surgical Procedures/psychology , Quality of Life/psychology , Age Factors , Aged , Aged, 80 and over , Canada/epidemiology , Cholecystectomy/statistics & numerical data , Comorbidity , Elective Surgical Procedures/statistics & numerical data , Female , Health Expenditures , Health Status , Humans , Male , Middle Aged , Patient Reported Outcome Measures , Quality-Adjusted Life Years , Retrospective Studies
19.
Otolaryngol Clin North Am ; 53(6): 1159-1170, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1027957

ABSTRACT

This review explores the changes to practice associated with COVID-19 for providers treating patients with head and neck cancer and laryngeal pathology. The aim of the review is to highlight some of the challenges and considerations associated with treating this patient population during the pandemic. Additionally, it seeks to discuss some of the areas of concern related to ramping up clinical volume.


Subject(s)
Coronavirus Infections/prevention & control , Elective Surgical Procedures/statistics & numerical data , Head and Neck Neoplasms/surgery , Infection Control/methods , Laryngectomy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/statistics & numerical data , Adult , Aged , Coronavirus Infections/epidemiology , Elective Surgical Procedures/methods , Female , Head and Neck Neoplasms/diagnosis , Humans , Laryngectomy/adverse effects , Male , Middle Aged , Occupational Health/statistics & numerical data , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Safety Management , Telemedicine/methods , United States
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