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1.
Minerva Chir ; 75(5): 298-304, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1456626

ABSTRACT

BACKGROUND: Morgagni hernias present technical challenges. The laparoscopic approach for repair was first described in 1992; however, as these hernias are uncommon in adult life, few data exist on the optimal method for surgical management. The purpose of this study was to analyze a method for laparoscopic repair of Morgagni giant hernias using laparoscopic primary closure with V lock (Medtronic, Covidien). METHODS: This case series describes a method of laparoscopic Morgagni hernia repair using primary closure. In all patients, a laparoscopic transabdominal approach was used. The content of the hernia was reduced into the abdomen, and the diaphragmatic defect was closed with a running laparoscopic suture using a self-fixating suture. Clips were placed at the edges of the suture to secure the pledged sutures to both the anterior and posterior fascia. Demographic data such as BMI and operative and postoperative data were collected. RESULTS: Retrospectively collected data for 9 patients were analyzed. There were 1 (11.1%) males and 8 (88.8%) females. The median BMI was 29.14±52 kg/m2. The median operative time was 80±25 minutes. There were no intraoperative complications or conversions to open surgery. Patients began a fluid diet on the first postoperative day and were discharged after a median hospital stay of 3±1.87 days. In a median follow-up of 36 months, we did not observe any recurrences. CONCLUSIONS: Transabdominal laparoscopic approach with primary closure of the diaphragmatic defect is a viable approach for the repair of Morgagni hernia. In our experience, the use of laparoscopic transabdominal suture fixed to the fascia allowed the closure of the defect laparoscopically with minimal tension on the repairs.


Subject(s)
Abdominal Wound Closure Techniques , Hernias, Diaphragmatic, Congenital/surgery , Herniorrhaphy/methods , Laparoscopy , Suture Techniques , Aged , Body Mass Index , Fasciotomy , Female , Hernias, Diaphragmatic, Congenital/diagnostic imaging , Humans , Length of Stay , Male , Medical Illustration , Operative Time , Retrospective Studies
2.
J Laryngol Otol ; 135(10): 848-854, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1454702

ABSTRACT

OBJECTIVE: The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. METHOD: A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. RESULTS: A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. CONCLUSION: Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.


Subject(s)
Dissection/adverse effects , Facial Nerve/surgery , Hemostasis, Surgical/instrumentation , Parotid Gland/surgery , Blood Loss, Surgical/statistics & numerical data , Drainage/trends , Electrocoagulation/adverse effects , Facial Paralysis/epidemiology , Female , Humans , Length of Stay/statistics & numerical data , Male , Meta-Analysis as Topic , Middle Aged , Operative Time , Outcome Assessment, Health Care , Postoperative Period , Surgical Instruments/adverse effects
3.
J Laryngol Otol ; 135(5): 452-457, 2021 May.
Article in English | MEDLINE | ID: covidwho-1303725

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy. METHOD: The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014. RESULTS: There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05-0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11-0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters. CONCLUSION: Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.


Subject(s)
Internship and Residency , Parotid Gland/surgery , Postoperative Complications/epidemiology , Salivary Gland Diseases/surgery , Adult , Aged , Aged, 80 and over , Clinical Competence , Female , Humans , Length of Stay , Male , Middle Aged , Operative Time , Quality Improvement , Reoperation , Retrospective Studies
5.
Ann R Coll Surg Engl ; 103(5): 354-359, 2021 May.
Article in English | MEDLINE | ID: covidwho-1121418

ABSTRACT

INTRODUCTION: The initial intercollegiate surgical guidance from the UK during the COVID-19 pandemic resulted in significant changes to practice. Avoidance of laparoscopy was recommended, to reduce aerosol generation and risk of virus transmission. Evidence on the safety profile of laparoscopy during the pandemic is lacking. This study compares patient outcomes and risk to staff from laparoscopic and open gastrointestinal operations during the COVID-19 pandemic. METHODS: Single-centre retrospective study of gastrointestinal operations performed during the peak of the COVID-19 pandemic. Demographic, comorbidity, perioperative and survival data were collected from electronic medical records and supplemented with patient symptoms reported at telephone follow up. Outcomes assessed were: patient mortality, illness among staff, patient COVID-19 rates, length of hospital stay and postdischarge symptomatology. RESULTS: A total of 73 patients with median age of 56 years were included; 55 (75%) and 18 (25%) underwent laparoscopic and open surgery, respectively. All-cause mortality was 5% (4/73), was related to COVID-19 in all cases, with no mortality after laparoscopic surgery. A total of 14 staff members developed COVID-19 symptoms within 2 weeks, with no significant difference between laparoscopic and open surgery (10 vs 4; p=0.331). Median length of stay was shorter in the laparoscopic versus the open group (4.5 vs 9.9 days; p=0.011), and postdischarge symptomatology across 15 symptoms was similar between groups (p=0.135-0.814). CONCLUSIONS: With appropriate protective measures, laparoscopic surgery is safe for patients and staff during the COVID-19 pandemic. The laparoscopic approach maintains an advantage of shorter length of hospital stay compared with open surgery.


Subject(s)
COVID-19/epidemiology , Digestive System Surgical Procedures/methods , Gastrointestinal Diseases/surgery , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Laparoscopy/methods , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Child , Conversion to Open Surgery/statistics & numerical data , Elective Surgical Procedures , Emergencies , Female , Health Personnel/statistics & numerical data , Humans , Laparotomy/methods , Length of Stay , Male , Middle Aged , Mortality , Operative Time , Retrospective Studies , Risk , SARS-CoV-2 , Treatment Outcome , United Kingdom , Young Adult
6.
Clin Transl Gastroenterol ; 12(2): e00314, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1097482

ABSTRACT

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, endoscopists have high risks of exposure to exhaled air from patients during gastroscopy. To minimize this risk, we transformed the oxygen mask into a fully closed negative-pressure gastroscope isolation mask. This study aimed to evaluate the effectiveness, safety, and feasibility of use of this mask during gastroscopy. METHODS: From February 28, 2020, to March 10, 2020, 320 patients undergoing gastroscopy were randomly assigned into the mask group (n = 160) or conventional group (n = 160). Patients in the mask group wore the isolation mask during gastroscopy, whereas patients in the conventional group did not wear the mask. The adenosine triphosphate fluorescence and carbon dioxide (CO2) concentration in patients' exhaled air were measured to reflect the degree of environmental pollution by exhaled air. Patients' vital signs, operation time, and adverse events during endoscopy were also evaluated. RESULTS: Four patients were excluded because of noncooperation or incomplete data. A total of 316 patients were included in the final analysis. The difference between the highest CO2 concentration around patients' mouth and CO2 concentration in the environment was significantly decreased in the mask group compared with the conventional group. There was no significant difference in the adenosine triphosphate fluorescence, vital signs, and operation time between the 2 groups. No severe adverse events related to the isolation mask, endoscopy failure, or new coronavirus infection during follow-up were recorded. DISCUSSION: This new isolation mask showed excellent feasibility of use and safety compared with routine gastroscopy during the COVID-19 pandemic.


Subject(s)
COVID-19/transmission , Gastroscopy/adverse effects , Masks/virology , Patient Isolators/virology , Adenosine Triphosphate/metabolism , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Carbon Dioxide/analysis , Case-Control Studies , Equipment Design/methods , Exhalation/physiology , Feasibility Studies , Female , Fluorescence , Gastroscopy/methods , Humans , Male , Masks/adverse effects , Masks/statistics & numerical data , Middle Aged , Operative Time , Prospective Studies , SARS-CoV-2/genetics , Safety , Treatment Outcome
7.
Colorectal Dis ; 23(6): 1562-1568, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1096721

ABSTRACT

AIM: The COVID-19 pandemic has forced surgeons to adapt their standard procedures. The modifications introduced are designed to favour minimally invasive surgery. The positive results obtained with intracorporeal resection and anastomosis in the right colon and rectum prompt us to adapt these procedures to the left colon. We describe a 'don't touch the bowel' technique and outline the benefits to patients of the use of less surgically aggressive techniques and also to surgeons in terms of the lower emission of aerosols that might transmit the COVID-19 infection. METHODS: This was an observational study of intracorporeal resection and anastomosis in left colectomy. We describe the technical details of intracorporeal resection, end-to-end stapled anastomosis and extraction of the specimen through mini-laparotomy in the ideal location. RESULTS: We present preliminary results of 17 patients with left-sided colonic pathologies, 15 neoplasia and two diverticular disease, who underwent four left hemicolectomies, six sigmoidectomies and seven high anterior resections. Median operating time was 186 min (range 120-280). No patient required conversion to extracorporeal laparoscopy or open surgery. Median hospital stay was 4.7 days (range 3-12 days). There was one case of anastomotic leak managed with conservative treatment. CONCLUSION: Intracorporeal resection and end-to-end anastomosis with the possibility of extraction of the specimen by a mini-laparotomy in the ideal location may present benefits and also adapts well to the conditions imposed by the COVID-19 pandemic. Future comparative studies are needed to demonstrate these benefits with respect to extracorporeal anastomosis.


Subject(s)
COVID-19/prevention & control , Colectomy/methods , Colonic Diseases/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , COVID-19/epidemiology , COVID-19/transmission , Female , Humans , Length of Stay , Male , Middle Aged , Operative Time
8.
Curr Oncol ; 28(1): 940-949, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1094234

ABSTRACT

BACKGROUND: COVID-19 has invariably changed the way lung cancer surgical care is provided in Canada. Despite relevant management guidelines, the way in which cancer care has been affected has yet to be described for thoracic surgical populations. Routine lung cancer physiologic and staging assessments are unique in that they are droplet producing and aerosolizing procedures. Our objective was to quantify the effect of the COVID-19 pandemic on surgical lung cancer care as perceived by practicing thoracic surgeons during the first wave of the pandemic in Canada. METHODS: An electronic survey was distributed to members of the Canadian Association of Thoracic Surgeons. The survey was designed to determine surgeon perception of lung cancer preoperative care during the Canadian pandemic-instilled period of resource reallocation compared to standard care. Planned analyses were exploratory in nature; with count and frequency distributions of responses quantified. RESULTS: Fifty-three thoracic surgeons completed the survey. Responses were collected from all Canadian provinces. Little change in access to preoperative imaging was noted. However, a significant decrease in access to lung function and bronchoscopy testing occurred. Pulmonary surgery was perceived to be lengthier with reduced operating theater availability. Despite decreased OR access, only 40% of surgeons were aware of respective institutional mitigation strategies. SUMMARY: The COVID-19 pandemic has had an impact on standard lung cancer care preoperative workup. Further inquiry using institutional data is warranted to quantify its impact on cancer patient outcomes. Assessing the extent and effects of newly present barriers to standard lung cancer care is essential in forming appropriate mitigation strategies and planning for future pandemic waves.


Subject(s)
COVID-19 , Lung Neoplasms/surgery , Preoperative Care/methods , Bronchoscopy , Canada , Humans , Lung Neoplasms/diagnostic imaging , Operating Rooms , Operative Time , Surveys and Questionnaires , Thoracic Surgical Procedures
9.
Otolaryngol Head Neck Surg ; 165(4): 532-535, 2021 10.
Article in English | MEDLINE | ID: covidwho-1072876

ABSTRACT

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to health care workers during myringotomy and tympanostomy tube (MT) insertion is unknown. To determine the need for enhanced precautions to prevent potential spread via aerosolized particles, we used an optical particle sizer to measure aerosol generation intraoperatively during a case series of MT insertion. We also discuss our institutional experience with safe pandemic-era perioperative practices. There was no measured increase in aerosol particle number during the procedure at a distance of 30 cm from the external auditory canal. These initial data are reassuring regarding the risk of SARS-CoV-2 transmission to the operating room team due to aerosol generation, but further study is necessary before making definitive recommendations.


Subject(s)
Aerosols , COVID-19/prevention & control , COVID-19/transmission , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Middle Ear Ventilation/adverse effects , COVID-19/epidemiology , Child , Humans , Operative Time
10.
J Surg Oncol ; 123(4): 834-841, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1070770

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has interfered with the treatment algorithm for patients with gastrointestinal (GIS) cancer, resulting in deferral of surgery. We presented the outcomes of our patients to evaluate whether surgery could be safely performed and followed-up without delaying any stage of GIS cancer during the pandemic. METHODS: This was an observational study of 177 consecutive patients who underwent elective GIS cancer surgery between March 11 and November 1, 2020. They were assessed regarding their perioperative and 60 days follow-up results for either surgical or COVID-19 status. Morbidity was determined according to the Clavien-Dindo classification (CDC). Continuous and categorical data were presented as median ± SD and number with percentage (%), respectively. RESULTS: The study included 44 gastric, 33 pancreatic, 40 colon, and 59 rectal cancer patients. All patients underwent surgery and received neo/adjuvant treatments without delay. The overall morbidity (CDC grade II-IV) and mortality rates were 10.1% and 3.9%, respectively. None of the patients or medical staff were infected with COVID-19 during the study period. CONCLUSION: GIS cancer surgery can be safely performed even within a pandemic hospital if proper isolation measures can be achieved for both patients and health workers. Regardless of the tumor stage, surgery should not be deferred, depending on unstandardized algorithms.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Gastrointestinal Neoplasms/surgery , Infection Control/organization & administration , Postoperative Complications/epidemiology , Adult , Aged , COVID-19/transmission , Elective Surgical Procedures , Feasibility Studies , Female , Follow-Up Studies , Gastrointestinal Neoplasms/mortality , Gastrointestinal Neoplasms/pathology , Humans , Length of Stay , Male , Middle Aged , Operative Time , Patient Selection , Tertiary Care Centers , Turkey
11.
Minerva Chir ; 75(5): 320-327, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-934709

ABSTRACT

BACKGROUND: During Coronavirus disease (COVID-19) pandemic entire countries rapidly ran out of intensive care beds, occupied by critically ill infected patients. Elective surgery was initially halted and acute non-deferrable surgical care drastically limited. The presence of COVID-19 patients into intensive care units (ICU) is currently decreasing but their congestion have restricted our therapeutic strategies during the last months. METHODS: In the COVID-19 era eighteen patients (8 men, 10 women) with a mean age of 80 years, needing undelayable abdominal surgery underwent awake open surgery at our Department. Prior to surgery, all patients underwent COVID-19 investigation. In all cases locoregional anesthesia (LA) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. RESULTS: Mean operative time was 104 minutes. In only one case conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. Only one perioperative complication occurred. Early readmissions after surgery were never observed. CONCLUSIONS: On the basis of our experience awake laparotomy under LA resulted feasible, safe, painless and, in specific cases, the only viable option. For patients presenting fragile cardiovascular and respiratory, reserves and in whom general anesthesia (GA) would presumably increase morbidity and mortality we encourage LA as an alternative to GA. In the COVID-19 era, it has become part of our ICU-preserving strategy allowing us to carry out undeferrable surgeries.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Frail Elderly , Laparotomy/statistics & numerical data , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Anesthesia, General , Anesthesia, Local/methods , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Emergencies/epidemiology , Female , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Male , Middle Aged , Operative Time , Pain, Postoperative/prevention & control , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Surgical Procedures, Operative/statistics & numerical data
12.
Can J Surg ; 63(6): E527-E529, 2020.
Article in English | MEDLINE | ID: covidwho-921481

ABSTRACT

SUMMARY: The cancellation of large numbers of surgical procedures because of the coronavirus disease 2019 (COVID-19) pandemic has drastically extended wait lists and negatively affected patient care and experience. As many facilities resume clinical work owing to the currently low burden of disease in our community, we are faced with operative booking protocols and procedures that are not mathematically designed to optimize efficiency. Using a subset of artificial intelligence called "machine learning," we have shown how the use of operating time can be optimized with a custom Python (a high-level programming language) script and an open source machine-learning algorithm, the ORTools software suite from the Google AI division of Alphabet Inc. This allowed the creation of customized models to optimize the efficiency of operating room booking times, which resulted in a reduction in nursing overtime of 21% - a theoretical cost savings of $469 000 over 3 years.


Subject(s)
Appointments and Schedules , Coronavirus Infections/prevention & control , Efficiency, Organizational/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Machine Learning , Operating Rooms/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Ontario , Operative Time , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology
13.
Can J Cardiol ; 37(6): 887-894, 2021 06.
Article in English | MEDLINE | ID: covidwho-898623

ABSTRACT

BACKGROUND: Left main coronary arterial (LMCA) atresia is a rare coronary arterial anomaly with extremely limited data on the optimal management. We aimed to report our single-surgeon experience of the ostioplasty in patients with LMCA atresia. METHODS: From July 2018 to December 2019, pediatric patients who presented with LMCA atresia and subsequently underwent surgical coronary ostioplasty were recruited into this retrospective study. Concomitant mitral repair was applied when the regurgitation was moderate or more severe. RESULTS: A total of 9 patients diagnosed with LMCA atresia were included. Mitral regurgitation was found in all of them, including 6 (66.7%) severe, 1 (11.1%) moderate, and 2 (22.2%) mild. In addition to ischemic lesions, which were found in 7 (77.8%) patients, structural mitral problems were also common (presented in 7 [77.8%] patients). All the patients underwent coronary ostioplasty with autologous pulmonary arterial patch augmenting the anterior wall of the neo-ostium. Mean aortic cross clamp time and cardiopulmonary bypass time was 88.1 ± 18.9 and 124.6 ± 23.6 minutes, respectively. During a median of 10.9 (range: 3.3 to 17.2) months' follow-up, there was only 1 death at 5 months after surgery. All survivors were recovered uneventfully with normal left-ventricular function; however, with 4 (50.0%) having significant recurrence of mitral regurgitation. CONCLUSIONS: With favourable surgical outcomes, coronary ostioplasty for LMCA atresia may be an option of revascularization. Structural mitral problems presented in majority patients, resulting in the requirement of concomitant mitral repair. However, the optimal technique of mitral repair remains unclear.


Subject(s)
Angioplasty/methods , Coronary Artery Disease , Coronary Vessel Anomalies , Mitral Valve Annuloplasty , Mitral Valve Insufficiency , Pulmonary Artery/transplantation , Aorta, Thoracic/surgery , Child, Preschool , Coronary Angiography/methods , Coronary Artery Disease/complications , Coronary Artery Disease/congenital , Coronary Artery Disease/surgery , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Female , Humans , Male , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Annuloplasty/methods , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Myocardial Revascularization/methods , Operative Time , Recurrence , Transplantation, Autologous/methods , Treatment Outcome
14.
Head Neck ; 43(2): 622-629, 2021 02.
Article in English | MEDLINE | ID: covidwho-886970

ABSTRACT

BACKGROUND: Guidelines regarding head and neck surgical care have evolved during the coronavirus-19 (COVID-19) pandemic. Data on operative management have been limited. METHODS: We compared two cohorts of patients undergoing head and neck or reconstructive surgery between March 16, 2019 and April 16, 2019 (pre-COVID-19) and March 16, 2020 and April 16, 2020 (COVID-19) at an academic center. Perioperative, intraoperative, and postoperative outcomes were recorded. RESULTS: There were 63 operations during COVID-19 and 84 operations during pre-COVID-19. During COVID-19, a smaller proportion of patients had benign pathology (12% vs 20%, respectively) and underwent thyroid procedures (2% vs 23%) while a greater proportion of patients underwent microvascular reconstruction±ablation (24% vs 12%,). Operative times increased, especially among patients undergoing microvascular reconstruction±ablation (687 ± 112 vs 596 ± 91 minutes, P = .04). Complication rates and length of stay were similar. CONCLUSIONS: During COVID-19, perioperative outcomes were similar, operative time increased, and there were no recorded transmissions to staff or patients. Continued surgical management of head and neck cancer patients can be provided safely.


Subject(s)
COVID-19 , Head and Neck Neoplasms/surgery , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Reconstructive Surgical Procedures/statistics & numerical data , Adult , Aged , Databases, Factual , Female , Humans , Male , Middle Aged , Neck Dissection/statistics & numerical data , Operative Time , Parotid Gland/surgery , Retrospective Studies , San Francisco , Thyroidectomy/statistics & numerical data , Treatment Outcome
15.
J Orthop Surg Res ; 15(1): 474, 2020 Oct 15.
Article in English | MEDLINE | ID: covidwho-863439

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has broken out and spread rapidly nationwide at the beginning of 2020, which has brought huge impacts to people and work. The current situation of prevention and control is severe and urges guidance for clinicians, especially for medical systems. In the hope of providing a reference and recommendation for the prevention and control of the COVID-19, we carried out research to improve the quality of patient care and prevention during this epidemic. METHODS: All of the staff were trained rapidly to master personal protection in our department. We reviewed the patients' discharged records who underwent surgery in our department during January 1 to March 1, 2019, and January 1 to March 1, 2020. The management of the surgery patients and flow charts were described and analyzed. Post-operation outcomes of the patients include duration, complications, surgical site infection (SSI), system infection, re-operation, and mortality. Both chi-squared test and Student's t test were performed to determine the relationship between the two periods in terms of post-operation outcomes. RESULTS: Descriptive statistics analysis revealed that demographic of the patients between the two periods is similar. We had benefited from the strict flowcharts, smart robot, and protection equipment during the perioperative managements for orthopedic patients. With the help of the strict flow charts and smart equipment, post-operation outcomes of the patients revealed that the rates of the complications and re-operation had been reduced significantly (p < 0.05), while duration of operation, SSI, and system infection had no significant difference between two periods (p > 0.05). No patient and staff caught COVID-19 infection or mortality during the epidemic. CONCLUSIONS: Our study indicated that medical quality and efficiency were affected little with the help of strategies described above during the epidemic, which could be a reference tool for medical staff in routine clinical practice for admission of patients around the world. What is more, the provided strategies, which may evolve over time, could be used as empirical guidance and reference for orthopedic peers to get through the pandemic and ensure the normal operation of the hospital.


Subject(s)
Coronavirus Infections/epidemiology , Efficiency, Organizational , Orthopedic Procedures , Perioperative Care , Pneumonia, Viral/epidemiology , Quality Assurance, Health Care , Betacoronavirus , COVID-19 , China/epidemiology , Female , Hospital Units , Humans , Infection Control , Male , Middle Aged , Operative Time , Pandemics , Personal Protective Equipment , Postoperative Complications , Reoperation , Retrospective Studies , Robotics , SARS-CoV-2 , Workflow
16.
Ann Thorac Surg ; 111(3): e181-e182, 2021 03.
Article in English | MEDLINE | ID: covidwho-796736

ABSTRACT

Concomitant coronavirus disease 19 (COVID-19) is a major risk factor for complications in any type of surgical procedure, especially in thoracic surgery, were the primary organ involved, the lung, is manipulated to perform parenchymal resection. However, it is not clear whether previous infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to increased morbidity and mortality for subsequent procedures once radiologic resolution is achieved. We report a young patient with lung cancer who successfully underwent a right upper lobectomy for primary adenocarcinoma by video-assisted thoracoscopic surgery with no complication in the early postoperative phase.


Subject(s)
COVID-19/epidemiology , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Pneumonectomy/methods , SARS-CoV-2 , Thoracic Surgery, Video-Assisted/methods , Carcinoma, Non-Small-Cell Lung/epidemiology , Comorbidity , Humans , Lung Neoplasms/epidemiology , Male , Middle Aged , Operative Time , Pandemics , Postoperative Period
17.
J Laparoendosc Adv Surg Tech A ; 31(4): 455-457, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-759898

ABSTRACT

Background: COVID-19 era has put laparoscopic surgery a risk procedure because of theoretical risk of viral transmission of COVID-19. However, safe evacuation of stagnant air during laparoscopic surgery is also necessary to safeguard health care warriors. Methods: We are reporting experience of 24 laparoscopic surgeries using a closed smoke evacuation/filtration system using a ultra low-particulate air (ULPA) filtration capability (ConMed AirSeal® System) at a single center between March 22, 2020, and May 30, 2020. All surgeries were either urgent or emergency in nature. Results: Totally, 17 males and 7 females who required urgent surgery. Most common indication for laparoscopic intervention was acute cholecystitis and complications related to acute cholecystitis. Owing to the closed smoke evacuation system, low intra-abdominal pressure was maintained during all surgeries. Of all procedures, only 0.8 time per procedure, the laparoscope taken out for cleaning. Mean time for completion of surgery was 58 minutes. Compliance of surgical staff was high due to the deemed safe smoke evacuation system. Mean of postoperative pain score was low. Mean hospital stay was 4.9 days. Conclusions: We propose to use a closed smoke evacuation/filtration system with ULPA filtration capability or similar devices in each minimally invasive surgery to reduce risks of transmission as minute as possible until we have enough knowledge about the pattern of disease transmission.


Subject(s)
COVID-19/prevention & control , Digestive System Surgical Procedures/instrumentation , Health Personnel , Laparoscopy/instrumentation , Occupational Exposure/prevention & control , Cholecystitis, Acute/complications , Cholecystitis, Acute/surgery , Digestive System Surgical Procedures/adverse effects , Emergencies , Female , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Operating Rooms , Operative Time , Pain, Postoperative/etiology , Pneumoperitoneum, Artificial , SARS-CoV-2
18.
J Endocrinol Invest ; 44(5): 1065-1073, 2021 May.
Article in English | MEDLINE | ID: covidwho-739704

ABSTRACT

OBJECTIVE: We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019. METHODS: The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25-February 25, 2020), phase II (February 26-March 19), phase III (March 20-April 20). RESULTS: There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers (P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital. CONCLUSION: The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate).


Subject(s)
COVID-19 , Pandemics , Thyroid Diseases/surgery , Thyroid Gland/surgery , Adult , Aged , Biopsy, Fine-Needle/statistics & numerical data , China , Female , Humans , Iran , Italy , Length of Stay , Male , Middle Aged , Neoplasm Staging , Operative Time , Postoperative Complications/epidemiology , Recurrent Laryngeal Nerve Injuries/epidemiology , Republic of Korea , Thyroid Diseases/pathology , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Thyroidectomy/adverse effects , Vocal Cord Paralysis/epidemiology , Vocal Cord Paralysis/etiology
19.
J Laparoendosc Adv Surg Tech A ; 31(3): 266-272, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-720927

ABSTRACT

Background: COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak. Materials and Methods: A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days. Results: During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions. Conclusions: An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.


Subject(s)
COVID-19/epidemiology , Carcinoma, Hepatocellular/surgery , Disease Management , Guideline Adherence , Hepatectomy/methods , Laparoscopy/methods , Liver Neoplasms/surgery , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/epidemiology , Comorbidity , Female , Humans , Length of Stay , Liver Neoplasms/epidemiology , Male , Middle Aged , Operative Time , Pandemics , SARS-CoV-2
20.
J Card Surg ; 35(11): 2908-2912, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-713646

ABSTRACT

BACKGROUND: The aim of this study is to investigate the effect of COVID-19 outbreak on congenital cardiac surgery practice in a single center. METHODS: The first case of COVID-19 in our country was seen on March 11th, 2020. The patients operated between March 11th, 2019-and March 10th, 2020 were taken as the pre-COVID group, and those operated between March 11th and May 11th, 2020 were taken as the COVID group. The data was retrospectively collected, and the two periods were compared. RESULTS: Monthly average number of cases which was 52 patients/month (626 patients in 12 months) before COVID decreased to 35 patients/month (70 patients in 2 months) during COVID periods (P < .01). During the pre-COVID period the median postoperative length of hospital stay was 3 (IQR: 1-5) days. During the COVID period, this decreased to 1 (IQR: 1-3) day (P < .01). During the pre-COVID period, the hospital expenses of 17% (8/47) of the foreign nationals were covered by their homeland. The remaining 83% (39/47) were paid from the asylum seekers' fund. The proportion of foreign nationals operated significantly decreased during the COVID period ([7%; 47/632 vs 1%; 1/70]; P = .04). No significant difference was observed in terms of STAT mortality scores and categories and postoperative results of the operations performed between the two periods. CONCLUSIONS: Congenital cardiac surgery practice can be safely maintained with restricted case volume during the pandemic period. It is alarming that patients in the deprived areas cannot access pediatric cardiac surgery and possibly other health services because of closure of the borders between countries.


Subject(s)
COVID-19/epidemiology , Cardiac Surgical Procedures/statistics & numerical data , Heart Defects, Congenital/surgery , Child, Preschool , Female , Humans , Infant , Length of Stay/statistics & numerical data , Male , Operative Time , Pandemics , Refugees/statistics & numerical data , Retrospective Studies , Turkey/epidemiology
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