Surgical management of suspected or confirmed SARS-CoV-2 (COVID-19)-positive patients: a model stemming from the experience at Level III Hospital in Emilia-Romagna, Italy

Zizzo, Maurizio; Bollino, Ruggero; Ruiz, Carolina Castro; Biolchini, Federico; Bonilauri, Stefano; Sergi, William; Annessi, Valerio

doi:10.1007/s00068-020-01377-2

Cited by 17 publications

(19 citation statements)

References 4 publications

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“…Regarding the surgical teams' organization, most of the published literature focuses on reducing the risk of infection by limiting the number of workforce members on each procedure [2,27]. Furthermore, the emphasis is made on rescheduling elective surgical procedures to rationalize hospital bed capacity.…”

Section: Discussionmentioning

confidence: 99%

International cooperation group of emergency surgery during the COVID-19 pandemic

Benítez

Ribeiro

Alexandrino

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams' adoption of recommendations during the pandemic. Methods Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. Results One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. Conclusion Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.

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Section: Discussionmentioning

confidence: 99%

International cooperation group of emergency surgery during the COVID-19 pandemic

Benítez

Ribeiro

Alexandrino

et al. 2020

Eur J Trauma Emerg Surg

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“…Inhospital non-operative management (NOM) has been suggested by recent literature for uncomplicated appendicitis, selected cholecystitis patients and colonic diverticulitis [21][22][23][24][25][26][27]. In the COVID-19 era, this strategy was suggested by many international recommendations [28][29][30] and has many advantages, rst of all protecting patients and staff from possible intrahospital and in theatre virus transmission, save human resources and devices, and make new ICU beds available. Moreover, recent literature reported an unexpected high rate of postoperative complications and mortality even after elective surgery [31,32], both for infected but asymptomatic patients before surgery and for patients contracting COVID-19 after surgery [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Waiting for the Second (Non)-Covid-19 Wave: Variations in Volume of Emergency Surgeries and of Emergency Department Accesses in a Third Level Hospital in Milan, Lombardy, During the Outbreak

Castoldi

Solbiati

Costantino

et al. 2020

Preprint

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Introduction: During the recent outbreak of COVID-19 (Corona VIrus Diseases 2019), Lombardy was the Italian region most affected, with 87,000 patients and 15,876 deaths (until May 26). Since February 22, well before the Government declared the state of emergency, a huge reduction of emergency surgeries was seen in Lombardy Hospitals, with a generalized drop of attendances in the Emergency Departments (EDs).Study Objective: The aim of this study is to report the experience of the ED of a third-level hospital in downtown Milan, Lombardy (IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico), and try to explain the causes of the observed phenomena.Methods: A retrospective, observational study was performed assessing the volume of emergency surgeries and of the attendances in the ED during the course of the pandemic, i.e. immediately before, during and after progressive community lockdown in response to the COVID-19 pandemic, comparing the same time periods in 2019.Results: Compared to the previous year, in 2020 a significant overall drop of emergency surgeries (60%, p<0.002) and of ED attendances (66%, p≅0) was observed. The drop was significant for medical ( 40%), surgical (74%), specialist fast track (92%), and psychiatric (60%) complaints, for domestic violence accesses (59%) and for patients who left the ED without being seen (LWBS) (76%). Conversely, deaths raised by 196%.Conclusion: During the COVID-19 outbreak the volume of urgent surgeries and the volume of patients accessing ED dropped. At the moment, it is not known if mortality of people who did not seek care increased during the pandemic. Further studies are needed to try to understand if such reductions during the COVID-19 pandemic will result in a rebound of patients left untreated, or in unwanted consequences on population health.

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“…Buildings open to the public are critical scenarios for the safety of the occupants, especially when crowd conditions occur (Dong et al 2018), and including those related to emergency events like a pandemic (Ronchi and Lovreglio 2020). The COVID-19 pandemic evidences how some issues in buildings fruition due to the long-lasting presence of people in closed built environment increase the pandemic spreading (Cirrincione et al 2020;Zizzo et al 2020;Wang et al 2020;Ronchi and Lovreglio 2020). As a consequence, policy makers and stakeholders were leaded to control the access to the buildings (mainly, by limiting the building occupancy) and even promote compulsory and widespread lockdowns, thus causing disruption of activities (Anderson et al 2020;Bruinen de Bruin et al 2020).…”

Section: Introductionmentioning

confidence: 99%

A probabilistic model to evaluate the effectiveness of main solutions to COVID-19 spreading in university buildings according to proximity and time-based consolidated criteria

D’Orazio

Bernardini

Quagliarini

2020

Preprint

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Crowds in buildings open to the public can alter the occupants’ safety in different emergency conditions, including those related to a pandemic. In this sense, university buildings are one of the most relevant scenarios in which the COVID-19 event clearly pointed out the stakeholders’ needs toward safety issues, especially because of the possibility of day-to-day presences of the same users (i.e. students, teachers) and overcrowding causing long-lasting contacts with possible “infectors” in such closed environments. While waiting for the vaccine, as for other public buildings, policy-makers’ measures to limit (second) virus outbreaks combine individual’s strategies (facial masks), occupants’ capacity and access control to avoid lockdowns and ensure adequate conditions for occupants. Simulators could support effectiveness evaluations of such measures. To fill this gap, this work proposes a quick and probabilistic simulation model based on consolidated proximity and exposure-time-based rules for virus transmission (confirmed by international health organizations). The building occupancy is defined according to university schedule, identifying the main “attraction areas” in the building (classrooms, break-areas). Scenarios are defined in terms of occupants’ densities, mitigation strategies, virus-related aspects. The model is calibrated on experimental data and applied to a relevant university building. Results demonstrate the model capabilities. In the case study, occupants’ capacity limitation could support the adoption of surgical masks by users instead of FFPk masks (thus improving users’ comfort issues). Preliminary correlations to combine acceptable mask filters-occupants’ density are proposed to support stakeholders in organizing users’ presences in the building during the pandemic.

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Surgical management of suspected or confirmed SARS-CoV-2 (COVID-19)-positive patients: a model stemming from the experience at Level III Hospital in Emilia-Romagna, Italy

Cited by 17 publications

References 4 publications

International cooperation group of emergency surgery during the COVID-19 pandemic

International cooperation group of emergency surgery during the COVID-19 pandemic

Waiting for the Second (Non)-Covid-19 Wave: Variations in Volume of Emergency Surgeries and of Emergency Department Accesses in a Third Level Hospital in Milan, Lombardy, During the Outbreak

A probabilistic model to evaluate the effectiveness of main solutions to COVID-19 spreading in university buildings according to proximity and time-based consolidated criteria

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