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Farthing TS, Jolley A, Nickel KB, Hill C, Stwalley D, Reske KA, Kwon JH, Olsen MA, Burnham JP, Dubberke ER, Lanzas C. Early coronavirus disease 2019 (COVID-19) pandemic effects on individual-level risk for healthcare-associated infections in hospitalized patients. Infect Control Hosp Epidemiol 2023; 44:1966-1971. [PMID: 37381734 PMCID: PMC10755158 DOI: 10.1017/ice.2023.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/08/2022] [Accepted: 04/10/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE We compared the individual-level risk of hospital-onset infections with multidrug-resistant organisms (MDROs) in hospitalized patients prior to and during the coronavirus disease 2019 (COVID-19) pandemic. We also quantified the effects of COVID-19 diagnoses and intrahospital COVID-19 burden on subsequent MDRO infection risk. DESIGN Multicenter, retrospective, cohort study. SETTING Patient admission and clinical data were collected from 4 hospitals in the St. Louis area. PATIENTS Data were collected for patients admitted between January 2017 and August 2020, discharged no later than September 2020, and hospitalized ≥48 hours. METHODS Mixed-effects logistic regression models were fit to the data to estimate patients' individual-level risk of infection with MDRO pathogens of interest during hospitalization. Adjusted odds ratios were derived from regression models to quantify the effects of the COVID-19 period, COVID-19 diagnosis, and hospital-level COVID-19 burden on individual-level hospital-onset MDRO infection probabilities. RESULTS We calculated adjusted odds ratios for COVID-19-era hospital-onset Acinetobacter spp., P. aeruginosa and Enterobacteriaceae spp infections. Probabilities increased 2.64 (95% confidence interval [CI], 1.22-5.73) times, 1.44 (95% CI, 1.03-2.02) times, and 1.25 (95% CI, 1.00-1.58) times relative to the prepandemic period, respectively. COVID-19 patients were 4.18 (95% CI, 1.98-8.81) times more likely to acquire hospital-onset MDRO S. aureus infections. CONCLUSIONS Our results support the growing body of evidence indicating that the COVID-19 pandemic has increased hospital-onset MDRO infections.
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Affiliation(s)
| | - Ashlan Jolley
- North Carolina State University, Raleigh, North Carolina
| | - Katelin B. Nickel
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Cherie Hill
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Dustin Stwalley
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Kimberly A. Reske
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Jason P. Burnham
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
| | - Erik R. Dubberke
- Division of Infectious Diseases, Washington University, St. Louis, Missouri
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Jolley A, Love W, Frey E, Lanzas C. Impacts of the COVID-19 pandemic on antimicrobial use in companion animals in an academic veterinary hospital in North Carolina. Zoonoses Public Health 2023; 70:393-402. [PMID: 37029504 PMCID: PMC10330401 DOI: 10.1111/zph.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 04/09/2023]
Abstract
Antimicrobial resistance (AMR) in bacterial pathogens reduces the effectiveness of these drugs in both human and veterinary medicine, making judicious antimicrobial use (AMU) an important strategy for its control. The COVID-19 pandemic modified operations in both human and veterinary healthcare delivery, potentially impacting AMU. The goal of this research is to quantify how antimicrobial drug prescribing practices for companion animals in an academic veterinary hospital changed during the pandemic. A retrospective study was performed using prescribing data for dogs and cats collected from the NC State College of Veterinary Medicine (NCSU-CVM) pharmacy, which included prescriptions from both the specialty referral hospital and primary care services. Records (n = 31,769) for 34 antimicrobial drugs from 2019-2020-before and during the pandemic-related measures at the NCSU-CVM-were compared. The prescribed antimicrobials' importance was categorized using the FDA's Guidance for Industry (GFI #152), classifying drugs according to medical importance in humans. A proportional odds model was used to estimate the probability of more important antimicrobials being administered in patients seen during the pandemic versus before (i.e., critically important vs. highly important vs. important). Rates of AMU per week and per patient visit were also compared. During the pandemic, cumulative antimicrobials prescribed per week were significantly decreased in most services for dogs. Weekly rates for Highly Important antimicrobials were also significantly lower in dogs. For important and critically important antimicrobials, rates per week were significantly decreased in various services overall. Rates of antimicrobial administration per patient visit were significantly increased for Highly Important drugs. Patients in the internal medicine, dermatology, and surgery services received significantly more important antimicrobials during the pandemic than before, while cardiology patients received significantly less. These results suggest that the pandemic significantly impacted prescribing practices of antimicrobials for companion animals in this study.
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Affiliation(s)
- Ashlan Jolley
- Department of Population Health and Pathobiology, NC State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - William Love
- Department of Population Health and Pathobiology, NC State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Erin Frey
- Department of Clinical Sciences, NC State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Cristina Lanzas
- Department of Population Health and Pathobiology, NC State University College of Veterinary Medicine, Raleigh, North Carolina, USA
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Rădulescu PM, Căluianu EI, Traşcă ET, Mercuţ D, Georgescu I, Georgescu EF, Ciupeanu-Călugăru ED, Mercuţ MF, Mercuţ R, Padureanu V, Streba CT, Călăraşu C, Rădulescu D. The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic. Diagnostics (Basel) 2023; 13:2446. [PMID: 37510190 PMCID: PMC10378087 DOI: 10.3390/diagnostics13142446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
We aimed to evaluate the outcomes and survival of patients with acute pancreatitis who shared the same clinical form, age, and sex before the pandemic, during the pandemic, and among those with confirmed COVID-19 infection upon hospital admission. This consideration used the sparse data in the existing literature on the influence of the pandemic and COVID-19 infection on patients with acute pancreatitis. To accomplish this, we conducted a multicentric, retrospective case-control study using propensity score matching with a 2:1 match of 28 patients with SARS-CoV-2 infection and acute pancreatitis, with 56 patients with acute pancreatitis pre-pandemic, and 56 patients with acute pancreatitis during the pandemic. The study outcome demonstrated a six-fold relative risk of death in patients with acute pancreatitis and SARS-CoV-2 infection compared to those with acute pancreatitis before the pandemic. Furthermore, restrictive measures implemented during the pandemic period led to a partial delay in the care of patients with acute pancreatitis, which likely resulted in an impairment of their immune state. This, in certain circumstances, resulted in a restriction of surgical treatment indications, leading to a three-fold relative risk of death in patients with acute pancreatitis during the pandemic compared to those with acute pancreatitis before the pandemic.
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Affiliation(s)
| | - Elena Irina Căluianu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Emil Tiberius Traşcă
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dorin Mercuţ
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ion Georgescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Eugen Florin Georgescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Maria Filoftea Mercuţ
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Răzvan Mercuţ
- Department of Plastic and Reconstructive Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Vlad Padureanu
- Internal Medicine Department, Country Hospital of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Costin Teodor Streba
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
| | - Cristina Călăraşu
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
| | - Dumitru Rădulescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Bernhard L, Amalanesan AF, Baumann O, Rothmeyer F, Hafner Y, Berlet M, Wilhelm D, Knoll A. Mobile service robots for the operating room wing: balancing cost and performance by optimizing robotic fleet size and composition. Int J Comput Assist Radiol Surg 2023; 18:195-204. [PMID: 36088614 PMCID: PMC9464430 DOI: 10.1007/s11548-022-02735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Integrating fleets of mobile service robots into the operating room wing (OR wing) has the potential to help overcome staff shortages and reduce the amount of dull or unhealthy tasks for humans. However, the OR wing has been little studied in this regard and the requirements for realizing this vision have not yet been fully identified. This includes fundamental aspects such as fleet size and composition, which we have now studied comprehensively for the first time. METHODS Using simulation, 150 different scenarios with varying fleet compositions, robot speeds and workloads were studied for a setup based on a real-life OR wing. The simulation included battery recharging cycles and queueing due to shared resources. RESULTS For all simulated scenarios we report results regarding total duration of execution, average task response times and fleet utilization. The relationship between these performance measures and global scenario parameters-such as fleet size, fleet composition, robot velocity and the number of operating rooms to be served-is visualized. CONCLUSION Our simulation-based studies have proven to be a valuable tool for individualized dimensioning of mobile robotic fleets, based on realistic workflows and environmental models. Thereby, important implications for future developments of mobile robots have been identified and a basis of decision-making regarding fleet size, fleet composition, robot capabilities and robot velocities can be provided. Due to costs, space limitations and safety requirements, these aspects must be carefully considered to successfully integrate mobile robotic technology into real-world OR wing environments.
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Affiliation(s)
- Lukas Bernhard
- Research Group MITI, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | | | - Oskar Baumann
- Chair of Robotics, Artificial Intelligence and Real-Time Systems, Technical University of Munich, Munich, Germany
| | - Florian Rothmeyer
- Chair of Materials Handling, Material Flow, Logistics, Technical University of Munich, Munich, Germany
| | - Yannic Hafner
- Chair of Materials Handling, Material Flow, Logistics, Technical University of Munich, Munich, Germany
| | - Maximilian Berlet
- Research Group MITI, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group MITI, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alois Knoll
- Chair of Robotics, Artificial Intelligence and Real-Time Systems, Technical University of Munich, Munich, Germany
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Cai X, Bi J, Zheng Z, Liu Y. Decision-making changes for patients and medical personnel in the management of acute appendicitis during the COVID-19 pandemic. BMC Emerg Med 2022; 22:170. [PMID: 36280806 PMCID: PMC9590391 DOI: 10.1186/s12873-022-00727-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes. METHODS Patients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences. RESULTS Compared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED. CONCLUSION The current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.
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Affiliation(s)
- Xuan Cai
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
| | - Jingtao Bi
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
| | - Zhixue Zheng
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
| | - Yaqi Liu
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
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Bakota B, Čretnik A. Advances in trauma and reconstructive surgery in Croatia despite the covid-19 pandemic. Injury 2021; 52 Suppl 5:S1-S2. [PMID: 34583828 PMCID: PMC8464402 DOI: 10.1016/j.injury.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Bore Bakota
- Trauma and Orthopaedics Department, Medical University Hospital LKH Graz, Austria.
| | - Andrej Čretnik
- Department of Traumatology, University Clinical Centre, Maribor, Slovenia
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Farber ON, Gomez GI, Titan AL, Fisher AT, Puntasecca CJ, Arana VT, Kempinsky A, Wise CE, Bessoff KE, Hawn MT, Korndorffer JR, Forrester JD, Esquivel MM. Impact of COVID-19 on presentation, management, and outcomes of acute care surgery for gallbladder disease and acute appendicitis. World J Gastrointest Surg 2021; 13:859-870. [PMID: 34512909 PMCID: PMC8394376 DOI: 10.4240/wjgs.v13.i8.859] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/31/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ongoing coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted both elective and acute medical care. Data from the early months suggest that acute care patient populations deferred presenting to the emergency department (ED), portending more severe disease at the time of presentation. Additionally, care for this patient population trended towards initial non-operative management.
AIM To examine the presentation, management, and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic.
METHODS A retrospective chart review of patients diagnosed with acute cholecystitis, symptomatic cholelithiasis, or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June, 2020 and in the same months of 2019. Patients were selected through a research repository using international classification of diseases (ICD)-9 and ICD-10 codes. Across both years, 313 patients were identified with either type of gallbladder disease, while 361 patients were identified with acute appendicitis. The primary outcome was overall incidence of disease. Secondary outcomes included presentation, management, complications, and 30-d re-presentation rates. Relationships between different variables were explored using Pearson’s r correlation coefficient. Variables were compared using the Welch’s t-Test, Chi-squared tests, and Fisher’s exact test as appropriate.
RESULTS Patients with gallbladder disease and appendicitis both had more severe presentations in 2020. With respect to gallbladder disease, more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort [50% (80) vs 35% (53); P = 0.01]. Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores [mean (SD) 1.39 (0.56) vs 1.16 (0.44); P = 0.02]. With respect to appendicitis, more patients were diagnosed with a perforated appendix at presentation in 2020 [20% (36) vs 16% (29); P = 0.02] and a greater percentage were classified as emergent cases using the emergency severity index [63% (112) vs 13% (23); P < 0.001]. While a greater percentage of patients were admitted to the hospital for gallbladder disease in 2020 [65% (104) vs 50% (76); P = 0.02], no significant differences were observed in hospital admissions for patients with appendicitis. No significant differences were observed in length of hospital stay or operative rate for either group. However, for patients with appendicitis, 30-d re-presentation rates were significantly higher in 2020 [13% (23) vs 4% (8); P = 0.01].
CONCLUSION During the COVID-19 pandemic, patients presented with more severe gallbladder disease and appendicitis. These findings suggest that the pandemic has affected patients with acute surgical conditions.
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Affiliation(s)
- Orly Nadell Farber
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Giselle I Gomez
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Ashley L Titan
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Andrea T Fisher
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Christopher J Puntasecca
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Veronica Toro Arana
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Arielle Kempinsky
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Clare E Wise
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Kovi E Bessoff
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Mary T Hawn
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - James R Korndorffer Jr
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Joseph D Forrester
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
| | - Micaela M Esquivel
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States
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Tolani MA, Fidelis L, Oyelowo N, Mustapha A, Adebayo WO, Okeke CJ, Alioke II, Abdulsalam KI, Aruna AA, Okonji NO, Okeke UA. Impact of the COVID-19 pandemic on surgical practice, training, and research in Nigeria. Pan Afr Med J 2021; 39:59. [PMID: 34422182 PMCID: PMC8363979 DOI: 10.11604/pamj.2021.39.59.23678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/14/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction the rising rate of SARS-CoV-2 infections has caused perceptible strain on the global health system. Indeed, this disease is also a litmus test for the resilience of the structures in the African health system including surgery. Therefore, this study aimed to determine the impact of the COVID-19 pandemic on surgical practice, training and research in Nigeria. Methods it was a cross-sectional study conducted over three weeks in Nigeria among doctors in 12 surgery-related specialties. Consenting participants filled a pre-tested online form consisting of 35 questions in 5 sections which assessed demographics, infection control measures, clinical practice, academic training, research program, and future trends. Data were analyzed using Statistical Package for Social Sciences Version 20. Results a total of 384 respondents completed the form. Their mean age was 38.3 years. Lockdown measures were imposed in the state of practice of 89.0% of respondents. Most participants reported a decrease in patient volume in outpatient clinics (95.5%) and elective operations (95.8%) compared to reports for emergency operations (50.2%). They also noted a decrease in academic training [Bedside teaching (92.1%), seminar presentation (91.1%) and journal presentation (91.8%)] and research (80.5%). Except in bedside teaching, those who had other virtual academic programmes were thrice the number of those who used in-person mode for the events. Conclusion COVID-19 pandemic has caused a significant change in pattern and a decrease in the volume of patients seen by surgeons in their practice as well as a decrease in the frequency of academic programs and research activities in Nigeria.
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Affiliation(s)
- Musliu Adetola Tolani
- Department of Surgery, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Lovely Fidelis
- Department of Surgery, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Nasir Oyelowo
- Department of Surgery, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Aisha Mustapha
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Wasiu Olusola Adebayo
- Department of Surgery, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Chike John Okeke
- Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos State, Nigeria
| | | | | | - Afeez Ajibade Aruna
- Department of Surgery, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Nkemdilim Oyetola Okonji
- Department of Surgery, Central Hospital Benin, Edo State Hospital Management Board, Benin City, Edo State, Nigeria
| | - Uche Albert Okeke
- Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Health facilities' readiness for safe surgical care provision in Uganda and the Eastern Democratic Republic of Congo during Ebola and COVID-19 era. BMC Health Serv Res 2021; 21:831. [PMID: 34404419 PMCID: PMC8370832 DOI: 10.1186/s12913-021-06870-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/02/2021] [Indexed: 12/22/2022] Open
Abstract
Objective This study aimed to assess health facilities’ readiness to provide safe surgical care during Ebola and COVID-19 era in Uganda and in the Eastern DR Congo. Methods A cross-sectional study was conducted in selected national, regional referral and general hospital facilities in Uganda and in the eastern part of DR Congo from 1st August 2020 to 30th October 2020. Data was analysed using Stata version 15. Results The participation rate was of 37.5 % (72/192) for both countries. None of the hospitals fulfilled the readiness criteria for safe surgical care provision in both countries. The mean bed capacity of participating health facilities (HF) was 184 in Eastern DR Congo and 274 in Uganda with an average surgical ward bed capacity of 22.3 % (41/184) and 20.4 % (56/274) respectively. The mean number of operating rooms was 2 and 3 in Eastern DR Congo and Uganda respectively. Nine hospitals (12.5 %) reported being able to test for Ebola and 25 (34.7 %) being able to test for COVID-19. Postponing of elective surgeries was reported by 10 (13.9) participating hospitals. Only 7 (9.7 %) hospitals reported having a specific operating room for suspect or confirmed cases of Ebola or COVID-19. Appropriate Personal Protection Equipment (PPE) was reported to be available in 60 (83.3 %) hospitals. Most of the staff had appropriate training on donning and doffing of PPE 40 (55.6 %). Specific teams and protocols for safe surgical care provision were reported to be present in 61 (84.7 %) and 56 (77.8 %) respectively in Uganda and Eastern DR Congo participating hospitals. Conclusions The lack of readiness to provide safe surgical care during Ebola and COVID-19 era across the participating hospitals in both countries indicate a need for strategies to enhance health facility supplies and readiness for safe surgical provision in resource-limited settings.
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Aboul‐Enein MS, Ishak P, Bhambra M, Ricart P, Al‐makdase L, Mourad M, Wadley M, Perry A. At a glance: The impact of COVID‐19 on emergency general surgery. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mohamed Saad Aboul‐Enein
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
- Department of General Surgery, Faculty of Medicine Tanta University Tanta Egypt
| | - Peter Ishak
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
| | - Maninder Bhambra
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
| | - Pol Ricart
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
| | - Lisa Al‐makdase
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
| | - Moustafa Mourad
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
| | - Martin Wadley
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
| | - Anthony Perry
- Department of Upper Gastrointestinal and Bariatric Surgery Worcestershire Acute Hospitals NHS Trust Worcester UK
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Krutsri C, Singhatas P, Sumpritpradit P, Thampongsa T, Phuwapraisirisan S, Gesprasert G, Jirasiritham J. Impact of the COVID-19 pandemic on the outcome, morbidity, and mortality of acute care surgery patients: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021; 28:50-55. [PMID: 34568618 PMCID: PMC7710472 DOI: 10.1016/j.ijso.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Coronavirus disease (COVID-19) has impacted both emergency and elective surgical management owing to its highly infectious nature and the shortage of personal protective equipment. This study aimed to review the outcomes of emergency surgical conditions and trauma during the pandemic lockdown. MATERIAL AND METHODS We retrospectively reviewed and collected data from patients who attended the Acute Care Surgery Service from 1st April to May 31st, 2020 during Thailand's COVID-19 pandemic lockdown. We separated staff and performed preoperative COVID-19 swab testing on all patients to assess the requirement for personal protective equipment. Compared with previous years of service, of 2018 and 2019. Preoperative COVID-19 testing was performed using multiplex and manual RT-PCR. Morbidity and mortality, consultation time, and waiting time to surgery were analyzed. RESULTS A total of 61 patients were enrolled. The average age of patients was 53.8 years. The average consultation time, waiting time to surgery, and surgical duration were 10 min, 660 min, and 88.77 min, respectively. The average time taken to obtain the preoperative COVID-19 test result was 227.26 min. The morbidity and mortality rates were 9.84% and 1.64%, respectively. Compared with the same period in 2018 and 2019, consultation time was significantly faster (10 min; p = 0.033) and waiting time to surgery was significantly longer (660 min, respectively; p = 0.011). Morbidity and mortality between pandemic period and the previous year of service were not significantly different. No medical workers were infected with COVID-19. CONCLUSIONS During the COVID-19 pandemic, optimal triage of emergency patients is key. Waiting for preoperative COVID-19 swab testing in emergency case is safe and results in good outcomes. Although the waiting time to surgery was significantly longer owing to the time required to receive preoperative COVID-19 swab results, morbidity and mortality rates were unaffected.
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Affiliation(s)
- Chonlada Krutsri
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsasit Singhatas
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeda Sumpritpradit
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tharin Thampongsa
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Samart Phuwapraisirisan
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Goragoch Gesprasert
- Division of Vascular and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jakrapan Jirasiritham
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kumaira Fonseca M, Trindade EN, Costa Filho OP, Nácul MP, Seabra AP. Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis. Am Surg 2020; 86:1508-1512. [PMID: 33156694 PMCID: PMC8685472 DOI: 10.1177/0003134820972098] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. METHODS The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. RESULTS The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. CONCLUSION Further assessment of patients' concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.
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Affiliation(s)
| | - Eduardo N. Trindade
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Omero P. Costa Filho
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Miguel P. Nácul
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Artur P. Seabra
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
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13
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Zhou Y, Cen LS. Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China. World J Clin Cases 2020; 8:4349-4359. [PMID: 33083394 PMCID: PMC7559659 DOI: 10.12998/wjcc.v8.i19.4349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) is a global pandemic and has had a profound impact on our routine surgical activities. Acute appendicitis is the most common abdominal emergency worldwide. Therefore, it is highly essential to assess the influence the pandemic has on acute appendicitis.
AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.
METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing, China. Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019. Preoperative management, intraoperative protective measures, and postoperative management were conducted.
RESULTS After screening, six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group. The results of the nucleic acid test were negative. Of the 76 patients enrolled in the simple group, nine patients received medication therapy, and all others underwent surgery. From this same group, 66 patients were diagnosed with suppurative appendicitis, and one patient was diagnosed with perforated appendicitis after surgery. There were 14 patients in the complex group, for which the postoperative diagnosis indicated perforated appendicitis. The proportion of men with perforated appendicitis was higher than that in 2019 (P < 0.05). The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019 (P < 0.05). The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019 (P < 0.05). The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019 (P < 0.05). Online consultation after discharge was selected in 59 cases (65.6%). No perioperative infection with COVID-19 or long-term postoperative complications were found.
CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.
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Affiliation(s)
- Yuan Zhou
- Department of Gastrointestinal Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing 31400, Zhejiang Province, China
| | - Lu-Sha Cen
- Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Affiliation(s)
- Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, VIC 3004, Australia.
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Aygun N, Iscan Y, Ozdemir M, Soylu S, Aydin OU, Sormaz IC, Dural AC, Sahbaz NA, Teksoz S, Makay O, Emre AU, Haciyanli M, Icoz RG, Giles Y, Isgor A, Uludag M, Tunca F. Endocrine Surgery during the COVID-19 Pandemic: Recommendations from the Turkish Association of Endocrine Surgery. SISLI ETFAL HASTANESI TIP BULTENI 2020; 54:117-131. [PMID: 32617048 PMCID: PMC7326680 DOI: 10.14744/semb.2020.65902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
Abstract
The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures. Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage). In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic. We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.
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Affiliation(s)
- Nurcihan Aygun
- Department of Genaral Surgery, University of Health Sciences, Istanbul Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey
| | - Yalin Iscan
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Murat Ozdemir
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Selen Soylu
- Department of General Surgery, Malatya Dogansehir Training and Research Hospital, Malatya, Turkey
| | - Oguz Ugur Aydin
- Department of General Surgery, Division of Endocrine Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Ismail Cem Sormaz
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of General Surgery, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Health Practice and Research Center, Istanbul, Turkey
| | - Nuri Alper Sahbaz
- Department of General Surgery, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Health Practice and Research Center, Istanbul, Turkey
| | - Serkan Teksoz
- Department of General Surgery, Division of Endocrine Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ozer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ali Ugur Emre
- Department of General Surgery, Division of Endocrine Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Mehmet Haciyanli
- Department of General Surgery, IKCU Medical Faculty, Izmir, Turkey
| | - Recep Gokhan Icoz
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yasemin Giles
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Adnan Isgor
- Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul; Sisli Memorial Hospital, Istanbul, Turkey
| | - Mehmet Uludag
- Department of Genaral Surgery, University of Health Sciences, Istanbul Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey
| | - Fatih Tunca
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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