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3.
J Vasc Surg ; 72(4): 1166-1172, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32454232

ABSTRACT

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.


Subject(s)
Coronavirus Infections/therapy , Delivery of Health Care, Integrated/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Health Services Needs and Demand/legislation & jurisprudence , Pneumonia, Viral/therapy , Policy Making , Tertiary Care Centers/legislation & jurisprudence , Vascular Surgical Procedures/legislation & jurisprudence , Ambulatory Care/legislation & jurisprudence , Ambulatory Care/organization & administration , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Delivery of Health Care, Integrated/organization & administration , Health Services Needs and Demand/organization & administration , Hospital Departments/legislation & jurisprudence , Hospital Departments/organization & administration , Host-Pathogen Interactions , Humans , Infection Control/legislation & jurisprudence , Infection Control/organization & administration , Occupational Health/legislation & jurisprudence , Pandemics , Patient Care Team/legislation & jurisprudence , Patient Care Team/organization & administration , Patient Safety/legislation & jurisprudence , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Program Evaluation , SARS-CoV-2 , Singapore/epidemiology , Tertiary Care Centers/organization & administration , Workload/legislation & jurisprudence
5.
Ann Surg ; 235(1): 145-51, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11753054

ABSTRACT

OBJECTIVE: To evaluate the efficacy of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS) in blood-conservation strategies for infrarenal aortic surgery. SUMMARY BACKGROUND DATA: Recent concerns over the risks of transfusion-related infection have resulted in sharp rises in the cost of blood preparations. Autologous transfusion may be a safe alternative to allogeneic transfusion, which has been associated with immune modulation and postoperative infection. METHODS: This multicenter prospective randomized trial compared standard transfusion practice with autologous transfusion combining ANH with ICS in 145 patients undergoing elective aortic surgery. The primary outcome measures were the proportion of patients requiring allogeneic blood and the volume of allogeneic transfusion. The secondary outcome measures were the frequency of complications, including postoperative infection, and postoperative hospital stay. RESULTS: The combination of ANH and ICS reduced the volume of allogeneic blood transfused from a median of two units to zero units. The proportion of patients transfused was 56% in allogeneic and 43% in autologous. There were no significant differences in complications or length of hospital stay. CONCLUSIONS: Both ANH and ICS were safe and reduced the allogeneic blood requirement in patients undergoing elective infrarenal aortic surgery.


Subject(s)
Aortic Diseases/surgery , Blood Transfusion, Autologous , Blood Transfusion , Hemodilution , Adult , Aged , Aged, 80 and over , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/surgery , Arterial Occlusive Diseases/surgery , Blood Transfusion, Autologous/adverse effects , Data Collection , Data Interpretation, Statistical , Female , Hemoglobins/analysis , Humans , Length of Stay , Male , Middle Aged , Odds Ratio , Prospective Studies , Sample Size , Transfusion Reaction
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