Introduction The initial intercollegiate surgical guidance from the UK during the COVID-19 pandemic resulted in significant changes to practice. Avoidance of laparoscopy was recommended, to reduce aerosol generation and risk of virus transmission. Evidence on the safety profile of laparoscopy during the pandemic is lacking. This study compares patient outcomes and risk to staff from laparoscopic and open gastrointestinal operations during the COVID-19 pandemic. Methods Single-centre retrospective study of gastrointestinal operations performed during the peak of the COVID-19 pandemic. Demographic, comorbidity, perioperative and survival data were collected from electronic medical records and supplemented with patient symptoms reported at telephone follow up. Outcomes assessed were: patient mortality, illness among staff, patient COVID-19 rates, length of hospital stay and postdischarge symptomatology. Results A total of 73 patients with median age of 56 years were included; 55 (75%) and 18 (25%) underwent laparoscopic and open surgery, respectively. All-cause mortality was 5% (4/73), was related to COVID-19 in all cases, with no mortality after laparoscopic surgery. A total of 14 staff members developed COVID-19 symptoms within 2 weeks, with no significant difference between laparoscopic and open surgery (10 vs 4; p=0.331). Median length of stay was shorter in the laparoscopic versus the open group (4.5 vs 9.9 days; p=0.011), and postdischarge symptomatology across 15 symptoms was similar between groups (p=0.135–0.814). Conclusions With appropriate protective measures, laparoscopic surgery is safe for patients and staff during the COVID-19 pandemic. The laparoscopic approach maintains an advantage of shorter length of hospital stay compared with open surgery.

Various studies have looked into the impact of the COVID-19 vaccine on large populations. However, very few studies have looked into the remote setting of hospitals where vaccination is challenging due to social structure, myths, and misconceptions. There is a consensus that elevated inflammatory markers such as CRP, ferritin, D-dimer correlate with increased severity of COVID-19 and are associated with worse outcomes. In the present study, through retrospective meta-analysis, we have looked into ~20 months of SARS-COV2 infected patients with known mortality status and identified predictors of mortality concerning their comorbidities, various clinical parameters, inflammatory markers, superimposed infections, length of hospitalization, length of mechanical ventilation and ICU stay. Studies with larger sample sizes have covered the outcomes through epidemiological, social, and survey-based analysis; however, most studies cover larger cohorts from tertiary medical centers. In the present study, we assessed the outcome of non-vaccinated COVID 19 patients in a remote setting for 20 months from January 1, 2020, to August 30, 2021, at CHI Mercy Health in Roseburg, Oregon. We also included two vaccinated patients from September 2021 to add to the power of our cohort. The study will provide a comprehensive methodology and deep insight into multi-dimensional data in the unvaccinated group, translational biomarkers of mortality, and state-of-art to conduct such studies in various remote hospitals.

A 28-year-old female-to-male transgender patient with unknown medical history was brought to the ED after being found unresponsive in the street with a helmet on his head. Trauma code was activated for presumed traumatic event. He was afebrile with normal BP, however, and was bradycardic at 54 beats/min and hypoxemic to 90% oxygen saturation on ambient air. His respirations were unlabored at 16 breaths/min. The patient was comatose with Glasgow coma scale of 7. Lung auscultation revealed decreased breath sounds on the left hemithorax. He was noted to have faint thoracic scarring bilaterally, which was presumed to be from bilateral mastectomies, along with acute deep abrasions suggestive of friction injuries with a dominant left-sided distribution. Cardiac and abdominal examination was unremarkable. Due to audible oropharyngeal secretions and signs of vomit on his clothing, the decision was made to proceed with intubation for airway protection.CBC count, basic metabolic panel, urine, and serum toxicology testing that included alcohol and salicylate levels were unrevealing. CT scan of the head was negative for acute ischemic stroke or hemorrhage. A postintubation chest radiograph is shown in Figure 1. Extended focused assessment with sonography for trauma was negative for free intraabdominal fluid.Critical care consultation was requested for further evaluation and chest tube placement.