Planning of surgical activity in the COVID-19 era: A proposal for a step toward a possible healthcare organization

Rocco, B.; Bagni, Alessandra; Bertellini, Elisabtta; Sighinolfi, Maria Chiara

doi:10.1177/0391560320938579

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…The establishment of instant messaging groups linking different hospitals enabled the quick identification of the regional availability of beds to facilitate the rapid patient transfer. 24,25 In the present series, on average surgery was performed 8 weeks (range: 6.7 to 9.2 weeks) after the end of the neoadjuvant therapy for locally advanced rectal cancer (LARC). The ESMO does not recommend delaying surgery after neoadjuvant therapy for LARC, except in extreme circumstances, and postponement should only be considered in patients who respond to the therapy, adding another cycle of the neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 96%

“…When the pressure on hospital resources was extremely high because there were too many Covid-19 patients hospitalized and the capacity of the ICU and ventilators was limited, surgical societies recommended redistributing hospital resources and introducting challenges on elective surgery. 24,25 Under these extreme circumstances, the priorities for colorectal cancer surgical treatment include cases of: nearly obstructed colon and rectal cancer, cancers with high transfusion requirements, cancers with evidence of local perforation and sepsis, and rectal cancer after neoadjuvant chemoradiation with no response to therapy. Cases of malignant polyps, prophylactic indications for hereditary conditions, and large benign asymtomatic polyps could be postponed until a decrease in the severity of the Covid-19 crisis.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the Covid-19 Pandemic on Colorectal Cancer Surgery in Madrid

Martínez

Borda

Chávez

et al. 2021

Journal of Coloproctology

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Introduction The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARS-CoV-2 infection. Methods In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p = 0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p = 0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid-19 patients could present a higher morbidity rate.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Impact of the Covid-19 Pandemic on Colorectal Cancer Surgery in Madrid

Martínez

Borda

Chávez

et al. 2021

Journal of Coloproctology

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“…Similar strategies of collaboration with the private sector have been used in other jurisdictions such as Ireland to facilitate the care of oncology patients. 30 Rocco et al, 31 described a possible organisation of a COVID-19 free hospital or hub similar to our structure, that include both patients' and workforce's preparation before entering the facility. The addition of a planned pathway for the whole workforce (physicians, nurses, cleaning and transporting crews, etc.)…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

Abou-Chedid

Evans

et al. 2021

Urologia

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Introduction: The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. Methods: A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017–2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a ‘clean’ site. Results: The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. Conclusion: There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as ‘clean’ sites can ensure continuity of care for cancer surgery and training needs.

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“…The outbreak of COVID-19 pandemic has led to a steep decrease in urological surgical and clinical activity between March and June 2020. The Italian Health System has undergone a sudden reorganization to face the global emergency 1 : non-urgent elective surgery, including a large amount of oncologic procedures, and outpatient visits have been postponed in order to provide resources for COVID-19 and slowdown of residents' activity: Feedback from a novel e-learning event and overview of the literature COVID-19 patients and non-deferrable cases. 2 The common perception is that this collapse in urological activity has deeply impaired the resident's training programs.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and slowdown of residents’ activity: Feedback from a novel e-learning event and overview of the literature

et al. 2021

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Objective: To evaluate the impact of an e-learning online event, created for supporting resident’s training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue. Methods: An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30–500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents. Results and limitations: Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents’ general perception towards web-based learning programs. Conclusions: The paper confirms residents’ satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists.

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Planning of surgical activity in the COVID-19 era: A proposal for a step toward a possible healthcare organization

Cited by 4 publications

References 15 publications

Impact of the Covid-19 Pandemic on Colorectal Cancer Surgery in Madrid

Impact of the Covid-19 Pandemic on Colorectal Cancer Surgery in Madrid

The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

COVID-19 and slowdown of residents’ activity: Feedback from a novel e-learning event and overview of the literature

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