The effects of COVID-19 pandemic on the provision of urgent surgery: a perspective from the USA

Cheeyandira, Abhiman

doi:10.1093/jscr/rjaa109

Cited by 24 publications

(32 citation statements)

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“…23 Also, staff shortages due to self-quarantine, contact exposure, coronavirus infection, or redeployment to critical care services have demanded triage even for urgent operations. 6 This premise, however, does not seem to explain our findings, as our hospital did not impose any restrictions on emergency surgery services during the outbreak. Otherwise, HMV has started preparing for a potential surge in the number of cases even before receiving alerts from the Brazilian national health care system.…”

Section: Discussionmentioning

confidence: 71%

“…5 Considering their high prevalence and the negative impact of delays in diagnosis and treatment, the number of urgent procedures would be expected to remain unchanged, even during the pandemic. 6 Surprisingly, a significant decrease in surgical emergencies and a higher proportion of complicated cases are being observed by several surgeons worldwide since the onset of the COVID-19 outbreak. We assessed the local impact of the pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital.…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

Fonseca

Trindade

Filho

et al. 2020

The American Surgeon™

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Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

Fonseca

Trindade

Filho

et al. 2020

The American Surgeon™

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“…While most medical resources were allocated to treat COVID-19 patients, emergency surgeries still needed to be handled. The COVID-19 pandemic has had a profound impact on our routine surgical activities, especially when it comes to emergency surgery[ 1 ]. Acute appendicitis, with an estimated lifetime risk reported to be 7%-8%, is the most common abdominal emergency worldwide, and emergency appendectomy is one of the most commonly performed surgical procedures for all age groups[ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China

Zhou¹,

Cen²

2020

WJCC

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BACKGROUND Coronavirus disease 19 (COVID-19) is a global pandemic and has had a profound impact on our routine surgical activities. Acute appendicitis is the most common abdominal emergency worldwide. Therefore, it is highly essential to assess the influence the pandemic has on acute appendicitis. AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic. METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing, China. Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019. Preoperative management, intraoperative protective measures, and postoperative management were conducted. RESULTS After screening, six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group. The results of the nucleic acid test were negative. Of the 76 patients enrolled in the simple group, nine patients received medication therapy, and all others underwent surgery. From this same group, 66 patients were diagnosed with suppurative appendicitis, and one patient was diagnosed with perforated appendicitis after surgery. There were 14 patients in the complex group, for which the postoperative diagnosis indicated perforated appendicitis. The proportion of men with perforated appendicitis was higher than that in 2019 ( P < 0.05). The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019 ( P < 0.05). The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019 ( P < 0.05). The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019 ( P < 0.05). Online consultation after discharge was selected in 59 cases (65.6%). No perioperative infection with COVID-19 or long-term postoperative complications were found. CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.

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“…Adding checklist specific to COVID-19 to the routinely used checklist before surgery is recommended because it minimizes the risk of errors or adverse events. [49] All the equipment and surgical items are prepared in the room before the patient is accepted to the OR. The trolleys for anesthesia are kept outside the room and all the drugs, medications and equipment that are needed by anesthesia are kept in the OR in a disposable tray.…”

Section: Preoperative Preparation Of the Operation Roommentioning

confidence: 99%

“…Closed suction systems should be used to avoid viral aerosol release, if not available, excessive suction should not be applied. [49,56] Extubation and Recovery of the Patient: Coughing or forced sputum removal after endotracheal extubation when patient is awakening, poses a significant risk for all staff. Thus, all staff other than the anesthesia team should leave the OR before extubation.…”

Section: Differences In Anesthesia and Preoperative Preparation (Covimentioning

confidence: 99%

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from Endocrine Surgery Society of Turkey

et al. 2020

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The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures. Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage). In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic. We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.

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The effects of COVID-19 pandemic on the provision of urgent surgery: a perspective from the USA

Cited by 24 publications

References 0 publications

Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from Endocrine Surgery Society of Turkey

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