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2.
BJS Open ; 5(4)2021 07 06.
Article in English | MEDLINE | ID: covidwho-1345713

ABSTRACT

BACKGROUND: Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS: Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS: From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION: The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.


Subject(s)
COVID-19/epidemiology , Surgical Procedures, Operative/methods , Evidence-Based Medicine , Humans , Organizational Innovation , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/standards
3.
Am J Infect Control ; 49(2): 151-157, 2021 02.
Article in English | MEDLINE | ID: covidwho-1336189

ABSTRACT

BACKGROUND: An outbreak of corona virus disease 2019 (COVID-19) in Wuhan, China has spread quickly across the world, the World Health Organization (WHO) has declared this a pandemic. COVID-19 can be transmitted from human to human and cause nosocomial infection that has brought great challenges to infection control in medical institutions. Due to the professional characteristics, the research hospital still received a large number of trauma emergency tasks during the outbreak. It is urgent to establish a graded prevention and control guidance of surgery. METHODS: Review the implementation of surgical grading control measures in this hospital during the epidemic of COVID-19. RESULTS: The surgical prevention measures based on patients with different risks included prescreening and preoperative risk assessment, preparation of operating room, medical staff protection and environmental disinfection measures, etc. From January 20 to March 5, 2020, a total of 4,720 operations had been performed in this hospital, of which 1,565 were emergency operations and 22 for medium-risk and high-risk patients who may have the 2019 severe acute respiratory syndrome coronavirus 2 infection. And there is no medical staff exposed during the implementation of protective measures. CONCLUSIONS: Through the risk assessment of surgical patients and adopting surgical grading control measures, the risk of severe acute respiratory syndrome coronavirus 2 spread during the surgical process can be reduced greatly.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Risk Management/methods , Surgical Procedures, Operative/statistics & numerical data , COVID-19/transmission , China/epidemiology , Health Plan Implementation , Humans , Risk Assessment , SARS-CoV-2 , Surgical Procedures, Operative/adverse effects
7.
Laryngoscope ; 131(11): E2749-E2754, 2021 11.
Article in English | MEDLINE | ID: covidwho-1242749

ABSTRACT

OBJECTIVES/HYPOTHESIS: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is transmitted by droplet as well as airborne infection. Surgical patients are vulnerable to the infection during their hospital admission. Some surgical procedures are classified as aerosol generating (AGP). STUDY DESIGN: Retrospective observational study of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. METHODS: Retrospective observational study in a tertiary healthcare center of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. RESULTS: There were 3,410 procedures reported during this period. The overall cross-infection rate from tested patients was 1.3% (4 patients), that is, 0.11% of all operations over 4 months. Ear, nose, and throat carried slightly higher rate of infection (0.4%) than gastroenterology (0.08%). The mortality rate was 0.3% (one gastroenterology patient from 304 positive cases) compared to 0% if surgery performed after recovery from SARSCoV-2 and 37.5% when surgery was conducted during the incubation period of the disease. Routine preoperative rapid screening tests and self-isolation are crucial to avoid the risk of cross-infection. Patients with underlying malignancy or receiving chemotherapy were more prone to pulmonary complications and mortality. CONCLUSION: The risk of SARS-COV-2 cross-infection after surgical procedure is very low. Preoperative screening and self-isolation together with personal protective measures should be in place to minimize the cross-infection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2749-E2754, 2021.


Subject(s)
COVID-19/transmission , Cross Infection/epidemiology , Disease Transmission, Infectious/prevention & control , Surgical Procedures, Operative/adverse effects , Aerosols , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cross Infection/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Female , Humans , Incidence , Male , Mass Screening/methods , Middle Aged , Mortality/trends , Outcome Assessment, Health Care , Particulate Matter/adverse effects , Patient Isolation/methods , Personal Protective Equipment/standards , Preoperative Period , Retrospective Studies , Risk Assessment/methods , SARS-CoV-2/genetics , Surgical Procedures, Operative/classification , Surgical Procedures, Operative/statistics & numerical data , United Kingdom/epidemiology
8.
Ann R Coll Surg Engl ; 103(6): 404-411, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1218301

ABSTRACT

INTRODUCTION: We aim to identify any changes in outcome for patients undergoing nonelective surgery at the start of the UK pandemic in our district general hospital. This was a single-centre retrospective cohort review of a UK district general hospital serving a population of over 250,000 people. METHODS: Participants were all patients undergoing a surgical procedure in the acute theatre list between 23 March to 11 May in both 2019 and 2020. Primary outcome was 90-day postoperative mortality. Secondary outcomes include time to surgical intervention and length of inpatient stay. RESULTS: A total of 132 patients (2020) versus 141 (2019) patients were included. Although overall 90-day postoperative mortality was higher in 2020 (9.8%) compared with 2019 (5.7%), this difference was not statistically significant (p=0.196). In 2020, eight patients tested positive for COVID-19 either as an inpatient or within 2 weeks of discharge, of whom five patients died. Time to surgical intervention was significantly faster for NCEPOD (National Confidential Enquiry into Patient Outcome and Death) code 3 patients in 2020 than in 2019 (p=0.027). There were no significant differences in mean length of inpatient stay. CONCLUSIONS: We found that patients were appropriately prioritised using NCEPOD classification, with no statistically significant differences in 90-day postoperative mortality and length of inpatient stay compared with the 2019 period. A study on a larger scale would further elucidate the profile and outcomes of patients requiring acute surgery to generate statistical significance.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Emergency Treatment/statistics & numerical data , Hospitals, District/statistics & numerical data , Hospitals, General/statistics & numerical data , Length of Stay/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Communicable Disease Control/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/mortality , Young Adult
9.
Ann R Coll Surg Engl ; 103(6): 395-403, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1218299

ABSTRACT

INTRODUCTION: Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection. METHODS: The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively. RESULTS: Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result. CONCLUSION: The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.


Subject(s)
COVID-19/epidemiology , Cross Infection/prevention & control , Hospitals, District/statistics & numerical data , Postoperative Complications/epidemiology , Surgical Procedures, Operative/methods , Adult , Aged , COVID-19/prevention & control , Critical Pathways , Female , Humans , Male , Middle Aged , Postoperative Complications/mortality , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/mortality , Surgical Procedures, Operative/statistics & numerical data , United Kingdom/epidemiology
10.
12.
J Glob Health ; 10(2): 020507, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1154782

ABSTRACT

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration: Registered in ClinicalTrials.gov: NCT04344197.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infection Control/statistics & numerical data , Mass Screening/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Physicians'/statistics & numerical data , Surgical Procedures, Operative/standards , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Cross Infection/virology , Cross-Sectional Studies , Hospitals/standards , Hospitals/statistics & numerical data , Humans , Infection Control/standards , Mass Screening/standards , Pneumonia, Viral/transmission , Policy , Practice Patterns, Physicians'/standards , SARS-CoV-2 , Surgical Procedures, Operative/adverse effects , Surveys and Questionnaires
15.
Ann Surg ; 273(1): 34-40, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1082368

ABSTRACT

OBJECTIVE: To evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery. SUMMARY BACKGROUND DATA: Although COVID-19 infection is usually associated with mild disease, it can lead to severe respiratory complications. Little is known about the perioperative outcomes of patients with COVID-19. METHODS: We examined patients who underwent urgent and emergent surgery at 2 hospitals in New York City from March 17 to April 15, 2020. Elective surgical procedures were cancelled throughout and routine, laboratory based COVID-19 screening was instituted on April 1. Mortality, complications, and admission to the intensive care unit were compared between patients with COVID-19 detected perioperatively and controls. RESULTS: Among 468 subjects, 36 (7.7%) had confirmed COVID-19. Among those with COVID-19, 55.6% were detected preoperatively and 44.4% postoperatively. Before the routine preoperative COVID-19 laboratory screening, 7.7% of cases were diagnosed preoperatively compared to 65.2% after institution of screening (P = 0.0008). The perioperative mortality rate was 16.7% in those with COVID-19 compared to 1.4% in COVID-19 negative subjects [aRR = 9.29; 95% confidence interval (CI), 5.68-15.21]. Serious complications were identified in 58.3% of COVID-19 subjects versus 6.0% of controls (aRR = 7.02; 95%CI, 4.96-9.92). Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were more common in those with COVID-19. The intensive care unit admission rate was 36.1% in those with COVID-19 compared to 16.4% of controls (aRR = 1.34; 95%CI, 0.86-2.09). CONCLUSIONS: COVID-19 is associated with an increased risk for serious perioperative morbidity and mortality. A substantial number of patients with COVID-19 are not identified until after surgery.


Subject(s)
COVID-19/epidemiology , Intensive Care Units/statistics & numerical data , Postoperative Complications/epidemiology , SARS-CoV-2 , Surgical Procedures, Operative/adverse effects , Adult , Aged , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morbidity/trends , Retrospective Studies , Survival Rate/trends , United States/epidemiology
16.
World J Surg Oncol ; 19(1): 8, 2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1059674

ABSTRACT

BACKGROUND: The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation. MAIN BODY: The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences). CONCLUSION: Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.


Subject(s)
COVID-19/complications , Neoplasms/surgery , Physical Functional Performance , SARS-CoV-2 , Sarcopenia/etiology , COVID-19/physiopathology , Humans , Myalgia/etiology , Surgical Procedures, Operative/adverse effects
17.
World J Surg Oncol ; 19(1): 8, 2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1021395

ABSTRACT

BACKGROUND: The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation. MAIN BODY: The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences). CONCLUSION: Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.


Subject(s)
COVID-19/complications , Neoplasms/surgery , Physical Functional Performance , SARS-CoV-2 , Sarcopenia/etiology , COVID-19/physiopathology , Humans , Myalgia/etiology , Surgical Procedures, Operative/adverse effects
18.
Eur J Trauma Emerg Surg ; 47(3): 693-702, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1008156

ABSTRACT

OBJECTIVE: To assess how the COVID-19 outbreak has affected emergency general surgery (EGS) care during the pandemic, indications for surgery, types of procedures, perioperative course, and final outcomes. METHODS: This is a retrospective study of EGS patients during the pandemic period. The main outcome was 30-day morbidity and mortality according to severity and COVID-19 infection status. Secondary outcomes were changes in overall management. A logistic regression analysis was done to assess factors predictive of mortality. RESULTS: One hundred and fifty-three patients were included. Half of the patients with an abdominal ultrasound and/or CT scan had signs of severity at diagnosis, four times higher than the previous year. Non-COVID patients underwent surgery more often than the COVID group. Over 1/3 of 100 operated patients had postoperative morbidity, versus only 15% the previous year. The most common complications were septic shock, pneumonia, and ARDS. ICU care was required in 17% of patients, and was most often required in the SARS-CoV-2-infected group, which also had a higher morbidity and mortality. The 30-day mortality in the surgical series was of 7%, with no differences with the previous year. The strongest independent predictors of overall mortality were age > 70 years, ASA III-IV, ESS > 9, and SARS-CoV-2 infection. CONCLUSIONS: Non-operative management (NOM) was undertaken in a third of patients, and only 14% of operated patients had a perioperative confirmation of -CoV-2 infection. The severity and morbidity of COVID-19-infected patients was much higher. Late presentations for medical care may have added to the high morbidity of the series.


Subject(s)
COVID-19 , Emergencies/epidemiology , Infection Control , Postoperative Complications , Surgical Procedures, Operative , COVID-19/epidemiology , COVID-19/prevention & control , Conservative Treatment/methods , Conservative Treatment/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , General Surgery/trends , Hospitals, Teaching/statistics & numerical data , Humans , Incidence , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Mortality , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/mortality , SARS-CoV-2 , Spain/epidemiology , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data
19.
Asian Cardiovasc Thorac Ann ; 29(5): 361-368, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-962771

ABSTRACT

BACKGROUND: A project to benchmark the consensus statements, guidelines, and recommendations on surgical management in the course of the COVID-19 pandemic was developed to assess the methodology used. Standard and practical approaches for COVID-19 management in surgical patients to date are not accessible, despite the magnitude of the pandemic. A plethora of consensus statements, guidelines, and recommendations on surgical management in the course of COVID-19 epidemic have been rapidly published in the last three months. METHODS: Each manuscript was scored on a seven-point scale in the different items and domains with the Appraisal of Guidelines for Research and Evaluation II. RESULTS: Nine guidelines that met the inclusion criteria were assessed. Transnational cooperation produced only one guideline. Multivariable analysis showed that improved scores of stakeholders' involvement were related to internationally developed guidelines. Clarity of presentation was related to the contribution of scientific societies due to greater rigor of development. The rigor of development produced guidelines with a high overall value. Higher healthcare expenses did not produce superior guidelines. CONCLUSIONS: Evaluated by the Appraisal of Guidelines for Research and Evaluation II, the methodological characteristic of consensus statements, guidelines, and recommendations on surgical management during COVID-19 pandemic was relatively low. International development should be recommended as a model for the development of best methodological quality guidelines.


Subject(s)
COVID-19 , Delivery of Health Care/standards , Evidence-Based Medicine/standards , Practice Guidelines as Topic/standards , Surgical Procedures, Operative/standards , Benchmarking/standards , Clinical Decision-Making , Consensus , Humans , Patient Safety/standards , Risk Assessment , Risk Factors , Surgical Procedures, Operative/adverse effects
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