Percepción de la pandemia COVID-19 en los servicios de cirugía en Colombia / Perception of the COVID-19 pandemic in the departments of surgery in Colombia

Introducción. La pandemia por COVID-19 ha llevado a modificar la estructura asistencial en los hospitales alrededor del mundo, buscando la mejor forma de adaptarse para responder al incremento de pacientes infectados por el virus, sin desatender las necesidades de los pacientes no afectados por el mismo. El objetivo de este trabajo es describir la percepción de la comunidad quirúrgica sobre el impacto que ha tenido la pandemia COVID-19 en los servicios de cirugía en Colombia.Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada compuesta por 10 preguntas de selección múltiple y 8 preguntas con ítems tipo Likert. Se distribuyó electrónicamente a residentes de cirugía general, cirujanos generales o sub-especialistas que tuvieran práctica clínica en Colombia. Resultados. Se incluyeron 464 participantes, 27.8 % fueron mujeres y 45.3 % cirujanos generales. Alrededor de la mitad residían en Bogotá (51.4 %) o trabajaban en un hospital universitario privado (48.3 %). El 78.8% de los encuestados consideraron que las recomendaciones de seguridad son efectivas y 76.6% se sienten seguros realizando procedimientos con ellas. Sin embargo, el 63% consideran que estas se cumplen parcialmente. Hasta el momento, 20% de los participantes reportó haber tenido contacto directo con pacientes COVID-19 positivos. Finalmente, la mayoría (93%) están de acuerdo con la cancelación de procedimientos electivos y están dispuestos a ser reubicados en otros servicios en caso de ser necesario. Conclusiones. Para el inicio de la fase de mitigación en Colombia existe consenso en la percepción del impacto de la pandemia COVID-19 en los servicios de cirugía. No se observó una variabilidad significativa respecto al nivel de entrenamiento ni al tipo de institución hospitalaria

Introduction: The COVID-19 pandemic has led to changes in the care structure in hospitals around the world, seeking the best way to adapt in response to the increase in patients infected with the virus, without neglecting the needs of patients not affected by it. The objective of this study is to describe the perception of the surgical community on the impact that the COVID-19 pandemic has had on the surgical services in Colombia.Methods: Descriptive cross-sectional study using a structured survey consisting of 10 multiple-choice questions and 8 questions with Likert-type items. It was distributed electronically to residents of general surgery, general surgeons, or sub-specialists who had clinical practice in Colombia.Results: 464 participants were included, 27.8% were women and 45.3% were general surgeons. About half resided in Bogotá (51.4%) or worked in a private university hospital (48.3%). 78.8% of the respondents considered that the safety recommendations are effective and 76.6% feel safe performing procedures with them. However, 63% con-sider that these are partially met. So far, 20% of participants reported having had direct contact with COVID-19 positive patients. Finally, the majority (93%) agree to the cancellation of elective procedures and are willing to be relocated to other services if necessary.Conclusions: There is a consensus in the perception of the COVID-19 pandemic impact in the surgery services without observing significant variability regarding the level of training or the type of hospital institution

Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis.

BACKGROUND: Colombia is a developing nation in need for efficient resource administration in fields such as health care, where innovation is constant. Since the introduction of laparoscopic appendectomy (LA), direct costs have been increasing without definitive results in terms of clinical outcomes. The objective of this study is to determine the cost-effectiveness of open appendectomy (OA) versus LA and thereby help surgeons in clinical decision-making in a limited resource setting. METHODS: A retrospective cost-effectiveness analysis comparing OA versus multiport LA during 2013 in a third-level university hospital (Hospital Universitario San Ignacio) in Bogota, Colombia was performed. Effectiveness was determined as the number of days in additional length of stay (LOS) due to the complications saved. A total of 377 clinical histories were collected by the authors and analyzed for the following variables: surgery type, conversion to open laparotomy, complications (surgical site infection, reintervention, and readmission), hospital LOS, and total cost of hospitalization for initial surgery and subsequent complications-related hospitalizations. The total accumulative costs and LOS for OA and LA plus complications were estimated. The cost-effectiveness threshold was set at US $46 (139,000 Colombian Peso [COP]), the cost of an additional day in LOS. An incremental cost-effectiveness ratio was calculated for OA as the comparator and LA as the intervention. RESULTS: The number of LA was 130 and of OA was 247. The two groups were balanced in terms of population characteristics. Complication rate was 13.7 % for OA and 10.4% for LA (P < 0.05), and LOS was 2 days for LA and OA (P = 0.9). No conversions from LA to OA were recorded. The total costs for complications for OA were US $8523 (25,569,220 COP) and US 3385 (10,157,758 COP) for LA. Cumulative costs including cost of surgery and complications and LOS for OA were US $65,753 (197,259,310 COP) and 297, respectively. Similarly, for LA were US $66,425 (199,276,948 COP) and 271, respectively. The incremental cost-effectiveness ratio was US $25.86 (77,601 COP) making LA a cost-effective alternative with a difference of US $20.76 (62,299 COP) under the cost-effectiveness threshold. CONCLUSIONS: LA is a cost-effective alternative over OA with an increasing cost of $25.85 per day of additional hospitalization due to complications saved. This is accounting the low cost of surgical interventions and complications in developing nations such as Colombia.