A rational approach to manage surgical procedures in COVID Era – A perspective based on experience in a private referral hospital

Gupta, Rama; Mohan, Bishav; Garg, Kamakshi; Taneja, Ashima; Virk, Satpal Singh; Grewal, Anju; Mahajan, Rajesh

doi:10.4103/joacp.joacp_420_20

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Similar reports have been published with very low mortality in an essential emergency as well as elective cases by establishing proper protocols, robust screening, and testing. [ 10 19 ]…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the management of surgical patients presenting in an emergency setting -Report from a tertiary referral centre

Das

Deotale

et al. 2021

Journal of Postgraduate Medicine

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Introduction: At the onset of the first wave of COVID-19 pandemic, the publications on managing surgical emergencies were sparse. Health care personnel were facing an unprecedented problem with limited information. On this background, we have reviewed the operational challenges faced and the protocols followed by us while managing emergency surgical patients. The clinical presentations, RT-PCR testing rates, trend of COVID-19 positivity in emergency surgical patients and its comparison to the general population, swab positivity among screen positive and negative patients, grade of COVID-19 affection, the outcomes in emergency surgical patients, and COVID-19 affection in treating personnel is studied. Patients and Methods: A protocol for triaging patients at presentation into screen positive or negative for COVID-19 was instituted. A proforma for all admitted patients over the period of March 2020 to August 2020 was maintained. A retrospective review of this data was carried out after Institutional Ethics Committee permission. Results: A total of 222 patients presented to the surgical emergency, of which 110 required admission. Of the admitted patients, 28 were COVID-19 positive. The positivity amongst admitted and operated patients increased to 50% and 66.67%, respectively in August. The difference in mortality rate amongst the operated COVID-19 positive (11.1%) and negative (14.28%) patients was nonsignificant. None of the treating doctors had to be quarantined during this period. Conclusions: The number of COVID-19 positive patients rose serially over the study period. The outcome was not affected by the COVID-19 status in mild cases. A high rate of COVID-19 positivity was seen in patients requiring emergency surgery. Universal precautions ensured delivering treatment to emergency patients in standard time. Testing should continue for all as screening alone is not effective as the virus spreads into the population. Proper protocols helped us to protect the health care workers.

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“…Similar reports have been published with very low mortality in an essential emergency as well as elective cases by establishing proper protocols, robust screening, and testing. [ 10 19 ]…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the management of surgical patients presenting in an emergency setting -Report from a tertiary referral centre

Das

Deotale

et al. 2021

Journal of Postgraduate Medicine

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Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

et al. 2022

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ObjectivesPatients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients.DesignSystematic review and meta-analysis.Data sourcesPubmed and Embase databases were searched through 20 February 2022.Eligibility criteriaAll COVID-19 articles including preoperative asymptomatic patients were included.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients.ResultsTwenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%.ConclusionsThe pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.

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Comprehensive Oral Rehabilitation Amidst COVID-19 Times with General Anaesthesia in the Primary Dentition in Children with Frankel's Definitely Negative Behaviour

M. Chengappa,

Angrish,

Mitra

et al. 2023

Indian Journal of Dental Sciences

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Accomplishing complete dental rehabilitation in a young child requires extra efforts, primarily because of the need to make use of behavior modification techniques, especially in the children requiring extensive dental procedures. Pharmacological means are sought when nonpharmacological techniques fail. General anesthesia (GA) comes to rescue in such cases. The applicability of GA in pediatric dentistry has been researched a lot and found to be effective. The case reports describe the challenges faced in managing the mutilated dentition in two children with Frankel's behavior rating as 1 (definitely negative behavior), in the midst of a pandemic where the pediatric dentist had to take care of the parental anxiety related to the child's oral conditions along with the concern of safety protocols followed in light of the ongoing COVID-19 pandemic. Complete oral rehabilitation was accomplished for both the children under GA.

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A rational approach to manage surgical procedures in COVID Era – A perspective based on experience in a private referral hospital

Cited by 4 publications

References 15 publications

Impact of the COVID-19 pandemic on the management of surgical patients presenting in an emergency setting -Report from a tertiary referral centre

Impact of the COVID-19 pandemic on the management of surgical patients presenting in an emergency setting -Report from a tertiary referral centre

Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

Comprehensive Oral Rehabilitation Amidst COVID-19 Times with General Anaesthesia in the Primary Dentition in Children with Frankel's Definitely Negative Behaviour

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