Emergency surgery during the COVID-19 pandemic: what you need to know for practice

Simone, Belinda De; Chouillard, Élie; Saverio, Salomone Di; Pagani, Léonardo; Sartelli, Massimo; Biffl, Walter L.; Coccolini, Federico; Pieri, Angela; Khan, Mansoor A.; Borzellino, Giuseppe; Campanile, Fabio Cesare; Ansaloni, Luca; Catena, Fausto

doi:10.1308/rcsann.2020.0097

Cited by 240 publications

(281 citation statements)

References 43 publications

Supporting

Mentioning

252

Contrasting

Unclassified

Order By: Relevance

“…According to a serological study about immunity against COVID developed by the Spanish Government, 11.4% of Madrid population have immunoglobulins against COVID [12], which could represent over 600.000 cases. The effect of COVID pandemic on emergency surgery has been a subject of analysis in several studies [13][14][15][16]. The results of the PIACO study are consistent with other studies in the current literature.…”

Section: Change In Epidemiological Patternsupporting

confidence: 79%

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

Guadalajara

Nova

Gonzalez

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundAnecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP - appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. MethodsThis was a multicentre, comparative study, whereby ASIP cases from March 14th to May 2nd 2019 acted as historical controls for the cohort of patients with the same pathology during the COVID-19 pandemic. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain).ResultsThe number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020. This reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. ConclusionsThe number of ASIP cases treated during the pandemic was reduced by more than one third mainly due to a dramatic reduction in mild cases. This also has represented a selection of severe cases. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances.The positive COVID-19 status itself did not have a direct impact on either morbidity or mortality. This is an interesting finding which if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

show abstract

Section: Change In Epidemiological Patternsupporting

confidence: 79%

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

Guadalajara

Nova

Gonzalez

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, systematic reviews and meta-analysis of RCT studies have recently reported that uncomplicated appendicitis can be successfully treated initially with antibiotics [27][28]. In a review by De Simone et al [29], it has been stated that in the pandemic period, non-operative approach can be applied unless acute appendicitis, acute cholecystitis, and adhesive small bowel obstructions develop peritonitis and no strangulation is suspected in incarcerated hernias. In another review by Gok et al [30], stated that nonoperatively follow-up should be considered when clinically appropriate for the patient.…”

Section: Resultsmentioning

confidence: 99%

Effects of COVID-19 pandemic on general surgical emergencies: Are some emergencies really urgent? Level 1 Trauma center experience

Sürek

Ferahman

Gemici

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: We aimed to investigate the effect of COVID-19 pandemic on general surgical emergencies. On the other hand, we analyzed the effectiveness of the measures we have taken and the incidence of COVID-19 of patients and healthcare professionals.Method: In the pandemic period between March 14 and May 15, 2020, and in the same period of the previous year, the files of patients who underwent emergency surgery and followed up nonoperatively were reviewed retrospectively. The incidence of COVID-19 was questioned in patients operated on in the pandemic period and in health professionals working in the general surgery department.Results: Demographic data were similar between the two groups. The number of patients operated on in the pandemic group (n = 103) was lower than during the control group (n = 252) (p = 0.001). In the pandemic group, there was a significant decrease in the number of surgeries of uncomplicated appendicitis, acute cholecystitis and incarcerated hernia (p=0.001, p=0.005, p=0.001, respectively). Others surgeries were similar in both groups. In the pandemic group, nonoperatively follow-up rates were significantly lower in acute mechanical intestinal obstruction and acute cholecystitis (p=0.001, p=0.011, respectively). The findings of COVID-19 were positive in 6(6/103, %5.82) patients undergoing emergency surgery. None of our doctors had COVID-19 infection (0/20). The findings were positive only in 2 nurses from the general surgery department(2/24, %8,33).Conclusion: In these and similar pandemics, we think that a new algorithm is needed to approach emergencies and the results of this study can help for that.

show abstract

“…Cui et al [73] carried out an observational study in 81 COVID-19 patients admitted in ICU and reported that the incidence of lower extremity deep venous thrombosis is 25% (20/81) and it may be related to poor prognosis. This group of patients showed a signi cant increase of Ddimer that could be considered a good index for identifying high-risk groups of venous thromboembolism (VTE) in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

Simone

Chouillard

Sartelli

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundSince the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity. The World Society of Emergency Surgery (WSES) conceived this position paper with the purpose of providing recommendations for the management of surgical, infected and non-infected, patients in emergency setting under COVID-19 pandemic in the safety of the patient and health care workers based on available evidences and experienced surgeons’opinion.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P)through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to provide a guide for emergency surgeons to perform safely surgery during this pandemic on the basis of evidence medicine and principles of mass casualty incident management to limit the diffusion of the infection among patients and health care workers. ConclusionsWe recommend screening for COVID-19 infection at emergency department, all surgical patients with clinical and epidemiologic features suspect for COVID-19 disease who are waiting for hospital admission and urgent surgery. The screening provides performing a RT-PCR naso-pharyngeal swab test and a baseline (non-contrast) chest CT or chest X-ray or lungs US, depending on skills and availability.The management of COVID-19 surgical patient is multidiplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every efforts to protect the operating room staff, in the safety of the patient . We recommend not being present during the intubation and extubation maneuvers (1A).To perform a safe surgical procedure, we recommend:-having a trained staff, wearing the necessary personal protective equipments, and an established protocol for the preoperative, peri-operative and postoperative management of the COVID-19 surgical patient;-being careful in the establishment and management of the artificial pneumoperitoneum, in the control of the hemostasis and of incisions to prevent any loss of biological fluids and contamination of the surgical staff;-using of all available devices to remove smoke and aerosol during the operation and a closed suction system for artificial pneumoperitoneum, especially if there is a risk of conversion to laparotomy.If it is not possible to perform surgery in a safe and protected environment, we recommend do not underestimating the highest risk of contamination and infection for health care workers and dissemination of the virus in the hospital and to consider transferring the patient in a COVID HUB hospital for the appropriate management.The administration of prophylactic anticoagulation with LMWH is recommended as soon as possible in COVID-19 patients to reduce thromboembolic risk related to the virus and sepsis, decreasing the mortality rate. We recommend to carefully administrating antibiotics in COVID-19 surgical patients for the high risk of selecting resistant bacteria, especially in patients admitted in ICU for mechanical ventilation. Early empirical antibiotic treatment should be targeted to results from cultures, with de-escalation of treatment as soon as possible. We recommend against empirical antifungal treatment in all surgical COVID-19 patients but to consider it in critically ill patients.

show abstract

Emergency surgery during the COVID-19 pandemic: what you need to know for practice

Cited by 240 publications

References 43 publications

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

Effects of COVID-19 pandemic on general surgical emergencies: Are some emergencies really urgent? Level 1 Trauma center experience

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

Contact Info

Product

Resources

About