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

Corona virus pandemic has affected all the 50 states in the USA. States such as NY, CA and WA being the most affected. According to the Centers for Disease Control and Prevention (CDC) website, as of 28 March 2020, the total number of cases in the USA is over 103 300 and number of deaths to 1668. In the coming weeks, COVID-19 rates are expected to begin skyrocketing and hit a peak in late April/May/June given lessons learned from China, Italy and others. COVID-19 has been declared a pandemic by the World Health Organization (WHO) as confirmed cases approach 575 444 patients with 26 654 deaths across over 160 countries, as of 28 March 2020. There is a lot of impact on management of the urgent and emergent cases. This article highlights the changes that are being made in delivering urgent and emergent surgical care during the pandemic.

Traumatic tricuspid valve rupture presenting as third-degree atrioventricular block.

BACKGROUND: Cardiac valve injury after blunt chest trauma is extremely rare, and the tricuspid valve is most commonly affected because of the anterior location of the right ventricle. Tricuspid valve insufficiency can range from a subclinical presentation to acute cardiac failure. OBJECTIVE: Diagnosis is difficult in trauma patients because hypotension is usually attributed to hemorrhage and anatomical cardiac injuries might be overlooked. CASE REPORT: This is a case of a 70-year-old patient with a history of rheumatic heart disease who suffered a complete rupture of her papillary muscles leading to tricuspid insufficiency after a motor vehicle collision. She presented with third-degree atrioventricular block. CONCLUSIONS: Consideration of screening for anatomical heart injuries in blunt trauma patients with new onset dysrhythmias is recommended to explain hypotension not attributable to hemorrhage.

Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis.

AIM: To identify variables that predict in-hospital length of stay (LOS) after laparoscopic ventral hernia repair (LVHR). METHODS: Univariate analysis of patient and intraoperative variables was conducted on an operating room database of LVHRs performed from April 2001 to April 2009. Analysis was performed using either chi-square or linear trend analysis, as appropriate. A multivariate logistic regression model was created manually, to determine independent variables that predict LOS. p Value <0.05 was considered significant. RESULTS: A total of 221 patients, with mean age of 56 years (range 25-88 years) underwent LVHR, for a total of 121 incisional and 100 primary ventral hernias. Of patients, 40% had incarcerated hernias and 25% had complex hernias (defined as multiple points of weakness on the anterior abdominal wall). The overall conversion rate to open operation was 6%. Mean LOS was 1.54 days (range 0-22 days). Eighty-six patients (39%) were discharged on the day of the procedure. Variables associated with significantly longer LOS on univariate analysis were incisional hernia (p = 0.000009), mesh size (p = 0.00007), complex hernia (p = 0.00009), incarcerated hernia (p = 0.0004), patient age (p = 0.0006), need for lysis of adhesions (p = 0.001), and female gender (p = 0.01). American Society of Anesthesiologists (ASA) grade >2, conversion to open procedure, and recurrent hernia were not associated with longer LOS. Four factors were independently associated with significant longer length of stay on multivariate logistic regression analysis (p < 0.05): mesh size (p = 0.00005), incarcerated hernia (p = 0.002), patient age (p = 0.018), and complex hernia (p = 0.035). CONCLUSIONS: Mesh size, incarcerated hernia, patient age, and complex hernia predict longer length of stay after laparoscopic ventral hernia repair.