Surgical Strategy During the COVID‐19 Pandemic in a University Metropolitan Hospital in Milan, Italy

Mariani, Nicolò Maria; Ceretti, Andrea Pisani; Fedele, Veronica; Barabino, Matteo; Nicastro, Vincenzo; Giovenzana, Marco; Scifo, G.; Nicola, Enrico De; Opocher, Enrico

doi:10.1007/s00268-020-05595-y

Cited by 11 publications

(20 citation statements)

References 14 publications

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“…Many possible ways of minimizing the risks were proposed: to postpone treatments or elective surgery for stable cancer in endemic areas, to provide patients with greater personal protection, and to offer more intensive surveillance or treatment. 52–54 For example, neoadjuvant treatments were recommended or increased 55 to defer surgical admission for as long as possible. 50,51,55,56 For other medical conditions requiring surgery under particular circumstances, such as relapse of inflammatory bowel disease, dedicated hubs were identified.…”

Section: Resultsmentioning

confidence: 99%

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

Lugli

Ottaviani

Botta

et al. 2020

Preprint

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Background: Italy has been one of the countries most affected by the SARS-CoV-2 pandemic and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. We investigated the management of non-COVID-19 patients across all medical specialties during the pandemic in Italy. Methods: A PRISMA guideline-based systematic review of the available literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from 20 February to 22 June, 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialties in combination with our geographical focus (Italy) and COVID-19. Findings: Of the 4643 potentially eligible studies identified by the search, 247 studies were included in the systematic review. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialties have been affected by the reorganization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine during the pandemic. Interpretation: Our work highlights the changes taking place in the Italian public healthcare system in order to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyze future directions for the healthcare system in the case of new pandemic scenarios.

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Section: Resultsmentioning

confidence: 99%

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

Lugli

Ottaviani

Botta

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Práticas anteriormente não consideradas passaram a ter status de essenciais para a prevenção de contaminação profissional e da contaminação cruzada 19 . As taxas de utilização de SO diminuíram, aumentou o tempo de espera e também a notificação de incidentes, tanto no serviço da instituição deste estudo quanto em outros 10,11 .…”

Section: Discussionunclassified

“…Muitos departamentos cirúrgicos relataram como a pandemia tem impactado nas suas rotinas de agendamento de cirurgias, alterado suas filas e sua forma de priorização. Contudo, há significativa falta de discussões de como a pandemia influenciou as rotinas, dentro da SO, de manejo da paramentação, montagem, desmontagem e desparamentação [7][8][9][10][11][12] .…”

Section: Introductionunclassified

Preparação de um centro cirúrgico do Nordeste do Brasil para cirurgias durante a pandemia da COVID-19

et al. 2021

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Objetivo: Relatar a experiência da preparação do centro cirúrgico de um hospital universitário brasileiro para o atendimento de cirurgias em pacientessuspeitos e confirmados de COVID-19. Método: Relato da experiência do centro cirúrgico de um hospital universitário do Nordeste do Brasil, em março e abrilde 2020, para o atendimento durante a pandemia da COVID-19. Resultados: A implementação do protocolo de atendimento a pacientes suspeitos e confirmadosde COVID-19 foi realizada por meio da sua elaboração por um time de profissionais norteados por diretrizes nacionais e internacionais, treinamentos e atualizações.Os ciclos de aprimoramento permitiram que o protocolo fosse aperfeiçoado ao longo dos dois meses relatados. Barreiras e facilitadores para o processosão discutidos e estratégias são elaboradas para adequações possíveis. Conclusão: Houve adequação de protocolos assistenciais relacionados à rotina de fluxo depacientes e da assistência em sala operatória no intuito de melhor atender os pacientes e reduzir os riscos de contaminação de outros pacientes e profissionais.

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“…In selected cases, when surgery is not feasible due to concomitant sepsis, severe comorbidities, poor performance status or bad timing (>72h from the onset of symptoms), the treatment of choice is represented by a conservative strategy consisting of antibiotic therapy, with success rate of 76% and recurrence of symptoms of 18% (11). When antibiotic therapy alone is unsuccessful, PTGBD is considered a safe and valid therapeutic option as a temporary and sometimes de nitive alternative to surgery, especially in elderly patients (>80 y o) with high surgical risk (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy.

Barabino

Piccolo

Trizzino

et al. 2020

Preprint

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BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODSWe analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTSThirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.

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Surgical Strategy During the COVID‐19 Pandemic in a University Metropolitan Hospital in Milan, Italy

Cited by 11 publications

References 14 publications

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

Preparação de um centro cirúrgico do Nordeste do Brasil para cirurgias durante a pandemia da COVID-19

COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy.

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