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4.
BMJ Case Rep ; 14(7)2021 Jul 26.
Article in English | MEDLINE | ID: covidwho-1327625

ABSTRACT

Anaesthesia for patients with severe lung fibrosis post COVID-19 infection requires special consideration. This is due to its propensity to cause perioperative anaesthetic catastrophe and possibility of cross infection among healthcare workers if not properly managed. This interesting article elaborates in detail the anaesthetic and surgical challenges in a morbidly obese patient who had a severe COVID-19 infection presenting for an elective spine surgery.


Subject(s)
COVID-19 , Obesity, Morbid , Elective Surgical Procedures , Humans , Obesity, Morbid/complications , Obesity, Morbid/surgery , SARS-CoV-2 , Spine/diagnostic imaging , Spine/surgery
5.
Sci Prog ; 104(2): 368504211009670, 2021.
Article in English | MEDLINE | ID: covidwho-1195898

ABSTRACT

As the coronavirus disease 2019 (COVID-19) spreads globally, hospital departments will need take steps to manage their treatment procedures and wards. The preparations of high-risk departments (infection, respiratory, emergency, and intensive care unit) were relatively well within this pandemic, while low-risk departments may be unprepared. The spine surgery department in The First Affiliated Hospital of Anhui Medical University in Hefei, China, was used as an example in this study. The spine surgery department took measures to manage the patients, medical staff and wards to avoid the cross-infection within hospital. During the outbreak, no patients or healthcare workers were infected, and no treatment was delayed due to these measures. The prevention and control measures effectively reduced the risk of nosocomial transmission between health workers and patients while providing optimum care. It was a feasible management approach that was applicable to most low-risk and even high-risk departments.


Subject(s)
COVID-19/prevention & control , Infection Control/methods , Pandemics , Patient Isolation/organization & administration , Patient Isolators/supply & distribution , SARS-CoV-2/pathogenicity , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , China/epidemiology , Cross Infection/prevention & control , Disinfection/methods , Disinfection/organization & administration , Health Personnel/education , Humans , Infection Control/organization & administration , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Orthopedic Procedures/instrumentation , Orthopedic Procedures/methods , Patient Isolation/methods , Patients' Rooms/organization & administration , Personal Protective Equipment/supply & distribution , Spine/surgery
6.
Reg Anesth Pain Med ; 46(6): 478-481, 2021 06.
Article in English | MEDLINE | ID: covidwho-1148173

ABSTRACT

BACKGROUND AND OBJECTIVES: The role of telemedicine in the evaluation and treatment of patients with spinal disorders is rapidly expanding, brought on largely by the COVID-19 pandemic. Within this context, the ability of pain specialists to accurately diagnose and plan appropriate interventional spine procedures based entirely on telemedicine visits, without an in-person evaluation, remains to be established. In this study, our primary objective was to assess the relevance of telemedicine to interventional spine procedure planning by determining whether procedure plans established solely from virtual visits changed following in-person evaluation. METHODS: We reviewed virtual and in-person clinical encounters from our academic health system's 10 interventional spine specialists. We included patients who were seen exclusively via telemedicine encounters and indicated for an interventional procedure with documented procedural plans. Virtual plans were then compared with the actual procedures performed following in-person evaluation. Demographic data as well as the type and extent of physical examination performed by the interventional spine specialist were also recorded. RESULTS: Of the 87 new patients included, the mean age was 60 years (SE 1.4 years) and the preprocedural plan established by telemedicine, primarily videoconferencing, did not change for 76 individuals (87%; 95% CI 0.79 to 0.94) following in-person evaluation. Based on the size of our sample, interventional procedures indicated solely during telemedicine encounters may be accurate in 79%-94% of cases in the broader population. CONCLUSIONS: Our findings suggest that telemedicine evaluations are a generally accurate means of preprocedural assessment and development of interventional spine procedure plans. These findings clearly demonstrate the capabilities of telemedicine for evaluating spine patients and planning interventional spine procedures.


Subject(s)
COVID-19 , Preoperative Care/methods , Spinal Diseases/surgery , Spine/surgery , Telemedicine , Humans , Middle Aged , Pandemics , SARS-CoV-2
7.
Spine (Phila Pa 1976) ; 45(18): 1285-1292, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-1104988

ABSTRACT

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: The aim of this study was to investigate the impact of COVID-19 pandemic on the clinical practices of spine surgeons within the Asia Pacific region. SUMMARY OF BACKGROUND DATA: COVID-19 pandemic had changed spine surgeons' clinical practices and their concerns toward personal and family risk of infection. METHODS: This cross-sectional survey was carried out from May 4, 2020 to June 4, 2020. The questionnaire was administered using REDCAP. The online questionnaire includes four sections. First section includes surgeon's demographics, background, type of clinical practice, and status of pandemic in their country. Second section includes volume and the type of spine surgery practice before the COVID pandemic. Third section includes changes of clinical practice during the pandemic and the last section was regarding their concern on COVID transmission. RESULTS: Total of 222 respondents from 19 countries completed the questionnaire. During the pandemic, 92.3% of the respondents felt their clinical practice was affected. 58.5% respondents reported reduced outpatient clinic hours and 74.6% respondents reported reduced operation theatre hours due to the enforcement by the hospital administration. The mean reduction of clinic volume for all countries was 48.1%. There was a significant reduction in the number of surgeries performed in Japan, Malaysia, India, Philippines, and South Korea. This was due to reduced patient load. More than 60% of respondents were worried being infected by COVID-19 virus and >68% were worried of transmission to their family members. CONCLUSION: COVID-19 pandemic has significantly affected the clinical and surgical practice of spine surgeons in the Asia Pacific region. Clinics were closed or the practice hours reduced. Similarly, surgical theaters were closed, reduced, or limited to semi-emergency and emergency surgeries. Spine surgeons were moderately concerned of contracting COVID-19 during their clinical practice but were extremely concerned to transmit this disease to their family members. LEVEL OF EVIDENCE: 4.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Spine/surgery , Surgeons , Surgical Procedures, Operative/statistics & numerical data , Asia , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Cross-Sectional Studies , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Practice Patterns, Physicians'/statistics & numerical data , SARS-CoV-2 , Surgeons/psychology , Surgeons/statistics & numerical data
8.
Spine (Phila Pa 1976) ; 46(7): 472-477, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-927287

ABSTRACT

STUDY DESIGN: Retrospective questionnaire study of all patients seen via telemedicine during the COVID-19 pandemic at a large academic institution. OBJECTIVE: This aim of this study was to compare patient satisfaction of telemedicine clinic to in-person visits; to evaluate the preference for telemedicine to in-person visits; to assess patients' willingness to proceed with major surgery and/or a minor procedure based on a telemedicine visit alone. SUMMARY OF BACKGROUND DATA: One study showed promising utility of mobile health applications for spine patients. No studies have investigated telemedicine in the evaluation and management of spine patients. METHODS: An 11-part questionnaire was developed to assess the attitudes toward telemedicine for all patients seen within a 7-week period during the COVID-19 crisis. Patients were called by phone to participate in the survey. χ2 and the Wilcoxon Rank-Sum Test were performed to determine significance. RESULTS: Ninety-five percent were "satisfied" or "very satisfied" with their telemedicine visit, with 62% stating it was "the same" or "better" than previous in-person appointments. Patients saved a median of 105 minutes by using telemedicine compared to in-person visits. Fifty-two percent of patients have to take off work for in-person visits, compared to 7% for telemedicine. Thirty-seven percent preferred telemedicine to in-person visits. Patients who preferred telemedicine had significantly longer patient-reported in-person visit times (score mean of 171) compared to patients who preferred in-person visits (score mean of 137, P = 0.0007). Thirty-seven percent of patients would proceed with surgery and 73% would proceed with a minor procedure based on a telemedicine visit alone. CONCLUSION: Telemedicine can increase access to specialty care for patients with prolonged travel time to in-person visits and decrease the socioeconomic burden for both patients and hospital systems. The high satisfaction with telemedicine and willingness to proceed with surgery suggest that remote visits may be useful for both routine management and initial surgical evaluation for spine surgery candidates.Level of Evidence: 3.


Subject(s)
COVID-19 , Patient Satisfaction , Spinal Diseases/surgery , Spine/surgery , Telemedicine , Adolescent , Adult , Aged , Ambulatory Care Facilities , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Surveys and Questionnaires , Young Adult
9.
World Neurosurg ; 145: e202-e208, 2021 01.
Article in English | MEDLINE | ID: covidwho-899667

ABSTRACT

OBJECTIVE: To determine the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on operative case volume in 8 U.S. neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period. METHODS: A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January through April 2020. Cases were grouped as elective cranial, elective spine, and nonelective emergent cases. Programs were surveyed regarding residents' perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data were analyzed for individual programs and pooled across programs. RESULTS: Across programs, the 2019 monthly mean ± SD case volume was 211 ± 82; 2020 mean ± SD case volumes for January, February, March, and April were 228 ± 93, 214 ± 84, 180 ± 73, and 107 ± 45. Compared with 2019, March and April 2020 mean cases declined 15% (P = 0.003) and 49% (P = 0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents required COVID-19 testing; however, to our knowledge, only 1 resident from the participating programs tested positive. CONCLUSIONS: This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the COVID-19 pandemic on residents' operative case volumes, identify deficiencies, and develop plans to mitigate any effects.


Subject(s)
COVID-19 , Neurosurgery/education , Pandemics , COVID-19 Testing , Education, Medical, Graduate/statistics & numerical data , Elective Surgical Procedures , Humans , Infectious Disease Transmission, Patient-to-Professional , Internship and Residency , Research , Retrospective Studies , Spine/surgery , Surveys and Questionnaires , United States
12.
World Neurosurg ; 145: e1-e6, 2021 01.
Article in English | MEDLINE | ID: covidwho-696570

ABSTRACT

In December 2019, coronavirus disease 2019 (COVID-19) was discovered in Wuhan, Hubei province, from where it spread rapidly worldwide. COVID-19 characteristics (increased infectivity, rapid spread, and general population susceptibility) pose a great challenge to hospitals. Infectious disease, pulmonology, and intensive care units have been strengthened and expanded. All other specialties have been compelled to suspend or reduce clinical and elective surgical activities. The profound effects on spine surgery call for systematic approaches to optimizing the diagnosis and treatment of spinal diseases. Based on the experience of one Italian region, we draw an archetype for assessing the current and predicted level of stress in the health care system, with the aim of enabling hospitals to make better decisions during the pandemic. Further, we provide a framework that may help guide strategies for adapting surgical spine care to the conditions of epidemic surge.


Subject(s)
COVID-19 , General Surgery/statistics & numerical data , Pandemics , Spine/surgery , COVID-19/epidemiology , Decision Making, Organizational , Decision Trees , Delivery of Health Care/statistics & numerical data , Emergency Service, Hospital , Humans , Italy/epidemiology , Spinal Diseases/surgery , Spinal Diseases/therapy , Time-to-Treatment
13.
Eur Rev Med Pharmacol Sci ; 24(13): 7519-7523, 2020 07.
Article in English | MEDLINE | ID: covidwho-676166

ABSTRACT

OBJECTIVE: Experience of Department of Oncologic and Degenerative Spine Surgery of Rizzoli Orthopaedic Institute during SARS-CoV-2 pandemic lockdown. PATIENTS AND METHODS: Retrospective observational study of surgically treated patients from 09th March 2020 to 04th May 2020. DATA COLLECTED: age, sex, type of disease, neurological status, days of hospitalization, complications and type of discharge. A comparison analysis with same period of the last year was performed in order to evaluate the impact of COVID-19 spreading on daily surgical activity. RESULTS: A total of 107 surgical procedures in 102 patients were performed from 09th March 2020 to 04th May 2020. Analysis showed a statistically significant difference in age, sex, ASIA class and type of treated disease compared to the same period of the last year (p=0.042, 0.006, 0.022 and 0.007, respectively). No statistically significant differences were observed in type of discharge, length of hospitalization and complications (p= 0.447, 0.261 and 0.127, respectively). 3 COVID-19 infections have been identified in hospitalized patients. 1 COVID-19 patient wad admitted from Emergency Department and was managed according to a dedicated path. CONCLUSIONS: Surgical activity was paradoxically increased during SARS-CoV-2 pandemic lockdown through the management of urgent and non-deferrable spinal disease with a low rate (3,9%) of COVID-19 infections.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/surgery , Coronavirus Infections/virology , Neoplasms/surgery , Neoplasms/virology , Pneumonia, Viral/surgery , Pneumonia, Viral/virology , Spine/surgery , Spine/virology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Child , Female , Humans , Italy , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
14.
Eur Spine J ; 29(8): 1789-1805, 2020 08.
Article in English | MEDLINE | ID: covidwho-526685

ABSTRACT

PURPOSE: Spine surgeons around the world have been universally impacted by COVID-19. The current study addressed whether prior experience with disease epidemics among the spine surgeon community had an impact on preparedness and response toward COVID-19. METHODS: A 73-item survey was distributed to spine surgeons worldwide via AO Spine. Questions focused on: demographics, COVID-19 preparedness, response, and impact. Respondents with and without prior epidemic experience (e.g., SARS, H1NI, MERS) were assessed on preparedness and response via univariate and multivariate modeling. Results of the survey were compared against the Global Health Security Index. RESULTS: Totally, 902 surgeons from 7 global regions completed the survey. 24.2% of respondents had prior experience with global health crises. Only 49.6% reported adequate access to personal protective equipment. There were no differences in preparedness reported by respondents with prior epidemic exposure. Government and hospital responses were fairly consistent around the world. Prior epidemic experience did not impact the presence of preparedness guidelines. There were subtle differences in sources of stress, coping strategies, performance of elective surgeries, and impact on income driven by prior epidemic exposure. 94.7% expressed a need for formal, international guidelines to help mitigate the impact of the current and future pandemics. CONCLUSIONS: This is the first study to note that prior experience with infectious disease crises did not appear to help spine surgeons prepare for the current COVID-19 pandemic. Based on survey results, the GHSI was not an effective measure of COVID-19 preparedness. Formal international guidelines for crisis preparedness are needed to mitigate future pandemics.


Subject(s)
Attitude of Health Personnel , Betacoronavirus , Coronavirus Infections/prevention & control , Orthopedic Surgeons , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Physicians' , Spine/surgery , Adult , Aged , COVID-19 , Coronavirus Infections/epidemiology , Female , Global Health , Humans , Linear Models , Male , Middle Aged , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , SARS-CoV-2 , Surveys and Questionnaires
15.
Clin Spine Surg ; 33(6): 244-246, 2020 07.
Article in English | MEDLINE | ID: covidwho-489841

ABSTRACT

STUDY DESIGN: This is a retrospective case analysis. OBJECTIVE: The objective of this study was to illustrate the numerical effects of regulatory restrictions of elective surgery at an orthopaedic university hospital. SUMMARY OF BACKGROUND DATA: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic all over the world places extraordinary demands on health care systems which are forced to ensure structural and personnel capacities. Consequently, hospitals may only perform urgent interventions. Spine patients, however, often need urgent surgery and, moreover, bear an above-average perioperative risk frequently requiring postoperative surveillance on intensive care units (ICUs). Facing this dilemma, we want to share our practice and its unexpected numerical effects. METHODS: We compare case statistics during normal operation, directly before and after implementation of regulatory measures. We also analyzed the differences in ICU utilization, complexity and duration of interventions and the patient population. RESULTS: Spine surgical interventions have been reduced by 42.7%. Regulatory restriction of "elective surgeries" in pandemic situations results in reduced ICU utilization, however in a disproportionate manner. Although other specialized surgeries can be reduced by 59%, surgical spine cases are only diminishable by 24%. The spine surgery-related ICU occupancy has been reduced by 35%. CONCLUSION: The disproportionate effect of case reduction needs to be considered while calculating resources released by regulatory limitation of "elective surgeries" on a (inter-)national level.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Elective Surgical Procedures/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Spine/surgery , COVID-19 , Communicable Disease Control , Critical Care/statistics & numerical data , Hospitals, University , Humans , Intensive Care Units/statistics & numerical data , Operative Time , Orthopedics/organization & administration , Retrospective Studies , Risk , SARS-CoV-2 , Switzerland/epidemiology
17.
World Neurosurg ; 140: e367-e372, 2020 08.
Article in English | MEDLINE | ID: covidwho-401403

ABSTRACT

BACKGROUND: The coronavirus identified in 2019 (COVID-19) pandemic effectively ended all major spine educational conferences in the first half of 2020. In response, the authors formed a "virtual" case-based conference series directed at delivering spine education to health care providers around the world. We herein share the technical logistics, early participant feedback, and future direction of this initiative. METHODS: The Virtual Global Spine Conference (VGSC) was created in April 2020 by a multiinstitutional team of spinal neurosurgeons and a neuroradiologist. Biweekly virtual meetings were established wherein invited national and international spine care providers would deliver case-based presentations on spine and spine surgery-related conditions via teleconferencing. Promotion was coordinated through social media platforms such as Twitter. RESULTS: VGSC recruited more than 1000 surgeons, trainees, and other specialists, with 50-100 new registrants per week thereafter. An early survey to the participants, with 168 responders, indicated that 92% viewed the content as highly valuable to their practice and 94% would continue participating post COVID-19. Participants from the United States (29%), Middle East (16%), and Europe (12%) comprised the majority of the audience. Approximately 52% were neurosurgeons, 18% orthopedic surgeons, and 6% neuroradiologists. A majority of participants were physicians (55%) and residents/fellows (21%). CONCLUSIONS: The early success of the VGSC reflects a strong interest in spine education despite the COVID-19 pandemic and social distancing guidelines. There is widespread opinion, backed by our own survey results, that many clinicians and trainees want to see "virtual" education continue post COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections , Orthopedic Surgeons/statistics & numerical data , Pandemics , Pneumonia, Viral , Spine/virology , COVID-19 , Europe , Health Personnel/education , Health Personnel/statistics & numerical data , Humans , SARS-CoV-2 , Spine/surgery , Surveys and Questionnaires , Telecommunications , Training Support/statistics & numerical data
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