Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Abstract

Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. Conclusion This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.

Reduced Vascular Practice and Increased Cardiovascular Mortality for COVID-19–Negative Patients

“…The analysis was based on the data reported by the national health institute (Istituto Superiore Sanità - ISS) and the national statistics institute (ISTAT), which are national not for profit institutions, supported by public funds. Mortality data are based on a real-time report of deaths in each single town, including more than 95% of the registered resident Italian population (Italian and not-Italian citizens) [ 1 , 2 , 3 , 4 ]. All causes of death are reported to ISS and ISTAT according to the International Classification of Diseases and Related Deaths (ICD 10) as recommended by the World Health Organization (WHO).…”

“…In Italy more than 106,000 deaths from COVID 19 have been reported up to March 30 th 2021; 250 health workers died from COVID19 infection and 110,266 health workers were diagnosed positive for COVID19 [ 1 , 2 , 3 , 4 ]. The pandemic has brought to unexpected consequences, including shortage of medical personnel and reluctance from patients to ask for medical help unless symptoms were severe [ 3 , 4 , 5 ]. Isolation rules were introduced for all hospitals in Italy including separate sections for COVID19 patients, diffuse testing and specific measures for health workers and patients.…”

Patient, Surgeon, and Health Care Worker Safety during the COVID-19 Pandemic

“…Most contentious was the aforementioned risk of contaminated bioaerosols. 28 ''Laparoscopy should generally not be used and considered, only in extremely selected cases'' was the initial Intercollegiate General Surgery Guidance on COVID-19 from March 25, 2020 from four Royal Colleges and Associations in England, Scotland, and Ireland and the ACS. 24,27,29,30 By April 2020, this initial strict warning had been qualified by the Australasian College, 3 Societies of Endoscopic Surgeons, and various authors 22,27,30,31 : ''Little or no evidence exists to favor an open approach over a laparoscopic/robotic one 31 ; MIS offers significant advantages to both patient care and mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present'' 27 ; ''the advantages of Minimally Invasive Surgery should not be sacrificed in the current crisis.…”

Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

“…So, considering criteria published in the literature (32,(34)(35)(36), pancreatic surgery should be centralized, this implies unavoidably an increase of interregional mobility and related healthcare costs, especially for patients from the region of southern Italy. During the Covid-19 pandemic, as we know from the survey written by Aldrighetti et al on HPB surgery in Italy (27), 72.8% of HPB centers showed a reduction of routine elective operations ≥50%, if we combine effects of centralization to the effects of the Covid-19 pandemic we understand how difficult it would be for patients to undergo pancreatic surgery in a quite fast, safe, and effective way (59). In this situation, we decided to analyse our outcomes from a low volume center for pancreatic surgery to overcome the impossibility to send patients to pancreatic surgery referral centers, considering their overload, ensuring to patients a high-quality service at the same time.…”