Consenting surgical patients for the risk of contracting COVID-19 during the hospital stay.

BACKGROUND/AIMS: Postoperative pulmonary complications occur in half of patients with perioperative COVID-19 and are associated with high mortality. The Royal College of Surgeons of England published guidance on recovery of surgical services during and after the COVID-19 pandemic. One part of this toolkit looked at unique considerations during the COVID-19 pandemic, in particular the risk of contracting COVID-19 while in the hospital. This quality improvement project sought to assess consent forms from the authors' surgical department to see if patients were being consented for the risks associated with COVID-19 during their stay in the hospital. METHODS: Over an 8-week period in October and November 2020, consent forms for patients under the general surgery department were audited four times against the Royal College of Surgeons of England's standards. Patients were included in the study if they were deemed to have capacity to consent to a procedure. Posters in the hospital, generic emails and teaching sessions were used as the interventions after each cycle of the audit. RESULTS: Baseline measurement showed that fewer than 37% of patients were consented for the risk of contracting COVID-19; this rose to almost 61%, 71% and 85% in the second, third and fourth parts of the project respectively. Year 1 and 2 core surgical trainees and clinical fellows below registrar level showed the greatest improvement, from consenting only 8% of patients up to 100% of patients, while specialty registrars showed improvement in consenting from 52% to 73%. The change was sustained 2 years after the initial interventions, with almost 60% of patients consented for the risk associated with in-hospital COVID-19 infection in March 2023. CONCLUSIONS: Errors or omission of important elements in documentation of patient consent can delay operations, expose hospital trusts to medicolegal risk and ultimately may represent a failure to fully respect patient autonomy. This project sought to evaluate consenting practice during the presence of COVID-19 in society. While the teaching session showed some improvement in the consenting for the risk of COVID-19, emails and visual posters increased the consent rates further.

The Effect of Weekend Surgery on Outcomes of Emergency Laparotomy: Experience at a High Volume District General Hospital.

Aims Emergency laparotomies (ELs) are associated with significant morbidity and mortality. Delays to the theater are inevitably associated with worse outcomes. Higher mortality has been reported with admissions over the weekend. The aim of this study is to compare the delays and outcomes of emergency laparotomies performed on weekdays (WD) and weekends (WE) at a high-volume, large district general hospital. Methods A retrospective review of a prospectively maintained database was performed for all patients who underwent general surgical emergency laparotomy between June and October 2021. Patient outcomes were compared between delayed and non-delayed surgeries as per the NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) classification. The primary outcome compared was the 30-day post-operative mortality and morbidity determined by the Clavein-Dindo class ≥2. Secondary outcomes included the time from booking to anaesthesia start time, i.e., time to theatre (TTT), delay in surgery, out-of-hours (OOH) surgery, and unplanned return to theatres. Results Of the 103 laparotomies included, 33% were performed over the weekend. The most common indication for emergency laparotomy was bowel obstruction (53.4 %), followed by perforation (28.2%). There was no significant difference in mortality, the TTT (p = 0.218), delay in surgery with respect to the NCEPOD category of intervention (p = 0.401), postoperative length of stay (p = 0.555), number of cases operated OOH as well as unplanned return to theatres. There was a significant difference in the morbidity of patients between the two groups (Clavein-Dindo class ≥2, p = 0.021). Conclusion With consistent consultant involvement, an equivalent standard of weekend emergency surgical service can be delivered.

Single Port Laparoscopic Total and Subtotal Colectomies for Inflammatory Bowel Disease in a District General Hospital.

Background: Single incision laparoscopic surgery (SILS) is expanding, enhancing the advantages of multi-port laparoscopic surgery (MLS). Limited literature exists regarding SILS total/subtotal colectomies for inflammatory bowel disease (IBD). Aim of the study was to present the initial experience with this type of approach in a district general hospital and extrapolate its feasibility and safety in this specific context based on gold standard outcomes reported in literature. Materials and Methods: Preoperative parameters, operative details and surgical outcomes of consecutive patients who underwent colonic SILS for IBD in a 5-year period were reviewed retrospectively. Median length of follow-up was 26 months. Results: Fourteen patients underwent SILS subtotal/total colectomy. Median body mass index was 25 (18.1-35). Two patients had previous abdominal surgeries. Median operating time was 202.5 minutes. Two cases were converted to open. Median length of stay was 5 days. Three patients presented complications. Three patients developed parastomal hernias (21.4%). Five out of 12 patients with ulcerative colitis declined further surgery, 3 are awaiting laparoscopic/SILS pouch formation, 1 underwent SILS pouch formation, 1 SILS ileo-rectal anastomosis and 1 patient had SILS completion proctectomy. One patient was not followed up. Conclusions: Despite literature data heterogeneity, these results provide support to the feasibility and applicability of SILS in the subgroup of patients who undergo subtotal/total colectomies for IBD, offering the option for subsequent SILS completion or restorative procedures. Further studies are required to explore the benefit of SILS over MLS (including cosmesis and quality of life) and non-inferiority of SILS regarding the parastomal hernia issue and the operative duration.