Translation, adaptation, and validation of the MeNTS score in colombian population: The MeNTS Col score.

Objective: To evaluate and validate the medically necessary and time sensitive score by testing the variables, in order to create a surgical preoperative score for procedure prioritization in COVID-19 pandemic in Colombia. Methods: A multicenter retrospective cross-sectional study of instrument validation with a cultural adaptation and translation into the Spanish language was carried out in Bogota, Colombia. Patients over 18 years of age who had undergone elective procedures of general surgery and subspecialties were included. The translation of the medically necessary and time sensitive score into Spanish was performed independently by two bilingual surgeons fluent in both English and Spanish. A final version of the Spanish questionnaire (MeNTS Col) for testing was then produced by an expert committee. After translation and cultural adaptation, it was submitted to evaluate the psychometric properties of the medically necessary and time sensitive score. Cronbach's α was used to represent and evaluate the internal consistency and assess reliability. Results: A total of 172 patients were included, with a median age of 54 years; of which 96 (55.8%) patients were females. The vast majority of patients were treated for general surgery (n = 60) and colon and rectal surgery (n = 31). The evaluation of the internal consistency of the scale items in Spanish version was measured, and values of 0.5 for 0.8 were obtained. In the reliability and validation process, Cronbach's α values in all items remained higher than 0.7. The new MeNTS Col model was analyzed, and a result of 0.91 was obtained. Conclusions: The Spanish version of the medically necessary and time sensitive, the MeNTS Col score, and its respective Spanish translation perform similarly to the original version. Therefore, they can be useful and reproducible in Latin American countries.

Effect of COVID-19 on Shoulder Arthroplasty at a Tertiary Care Medical Center in New York City.

Objective The COVID-19 pandemic led to an unprecedented pause in elective surgeries, including shoulder arthroplasty. We sought to determine whether clinical and/or demographic differences would be seen between patients who presented for shoulder arthroplasty during the pandemic compared with the previous year (2019). Methods Institutional records were queried for patients who underwent shoulder replacement between March 1 and July 1 of 2019 and 2020. Demographics, range of motion, surgical duration, hospitalization time, discharge disposition, and postoperative management were analyzed. Results The mean duration of surgery was 160 ± 50 minutes in 2020 and 179 ± 54 minutes in 2019 ( p = 0.13). The mean hospitalization time was 36 ± 13 hours in 2020 and 51 ± 40 hours in 2019 ( p = 0.04). In 2019, 96% of the patients participated in physical therapy, while 71% did it in 2020 ( p = 0.003). A total of 100% of the 2019 patients and 86% of the 2020 patients participated in an in-person postoperative follow-up ( p = 0.006). The 2019 patients reported for an office visit on average 14 ± 11 days after surgery; the 2020 patients waited 25 ± 25 days to return for a follow-up ( p = 0.10). Range of motion, age, American Society of Anesthesiologists (ASA) scores, and complication rates did not differ between the cohorts. Conclusion Patients presenting for surgery during the initial phase of the pandemic were demographically and clinically similar to 2019 patients. However, the length of stay was significantly reduced during the COVID-19 pandemic. Postoperative follow-up and physical therapy were delayed in 2020, but this did not lead to differences in complication or readmission rates compared with those of the 2019 cohort. Level of Evidence III.

[Evaluation of the effectiveness of the new perioperative model to recover surgical activity during the COVID-19 pandemic]. / Evaluación de la efectividad del nuevo modelo perioperatorio para recuperar la actividad quirúrgica durante la pandemia de COVID-19.

INTRODUCTION: The first wave of the COVID-19 pandemic caused the cancellation of elective interventions. After the improvement of the epidemiological situation, new models of care were applied in hospitals to restart the programmed surgical activity. The aim was to evaluate the effectiveness of the organizational model established to recover surgical activity during the transition period of the COVID-19 pandemic. METHODS: Retrospective observational study comparing patients who underwent schedule surgery from September 1 until October 31, 2020, study group, with a control group of the same period of time corresponding to the year 2019 at the General Hospital from the Vall d'Hebron University Hospital. RESULTS: The total population included 1,825 patients, 888 in the study group and 937 in the control group. Global surgical activity decreased 6.43% during the study period compared to the same period in 2019, with a 25.5% decrease in cancer surgeries. Seven patients became infected with SARS-CoV-2 during their hospital stay. In hospital mortality was 0.9% in the study group compared to 0.7% in control group (p=0.8). The survival rate in cancer patients at 90 days was lower in the study group (95.7% vs 98.7%; p=0.02). CONCLUSIONS: The change in the management model during the transition period of the COVID-19 pandemic allowed the recovery of programmed surgical activity to levels similar to those existing prior to the pandemic with a greater impact on cancer surgery.

Impact of the Suspension of Elective Surgeries for Adolescent Idiopathic Scoliosis during the COVID-19 Pandemic.

Objectives This study evaluated the radiographic progressions of scoliotic curves higher than 40° in patients with adolescent idiopathic scoliosis (AIS). These subjects waited for the surgical procedure while elective surgeries were on hold during the COVID-19 pandemic. In addition to radiographic progressions, this study described the quality of life of these patients. Methods This study is a retrospective cohort assessing 29 AIS patients with surgical indications registered in the Brazilian public healthcare service. We compared the scoliotic radiographic measurements in two moments: at the beginning of the interruption of elective surgeries due to the COVID-19 pandemic and when these procedures resumed. Results When comparing the radiographic measurements before and after the suspension of assessments for elective surgeries, we observed a significant increase in main curve angles ( p < 0.001), with variations ranging from 0 to 68° and a median value of 10°. In secondary curves, we observed an increase in angles from the proximal thoracic ( p < 0.001) and lumbar ( p = 0.001) regions. However, the increase in the main thoracic region was not significant ( p = 0.317). Conclusion The suspension of elective surgeries for AIS resulted in a significant increase in the radiographic values of patients' spine deformities. This increase harmed the quality of life of these subjects and their families.

Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation.

Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic.

BACKGROUND: Many institutions withheld elective lists and triaged surgeries during the peak of coronavirus disease 2019 (COVID-19) pandemic. As a result, older surgical patients have had to wait for rescheduled dates in a long waitlist. This study aimed to identify the psychological impact in these patients when they returned for surgery. METHODS: This was a cross-sectional study which included 153 patients aged ≥ 65 years undergoing elective surgery. Trained interviewers recruited and assessed psychological status pre-operatively with two validated questionnaires - Hospital Anxiety and Depression Scale (HADS) and 36-item Short Form Health Survey (SF-36). Specific questions were asked about their postponed surgeries, appetite and fear. RESULTS: A total of 36 out of 153 (23.5%) patients had their procedures deferred during the first wave of COVID-19 pandemic. Postponed cases were significantly based on the nature of surgery (p = 0.002), cancer diagnosis (p = 0.006) and surgical specialty (p = 0.023). Median HADS scores were higher for patients who were postponed (2.00 versus 4.00 for anxiety, p = 0.180 and 0.00 versus 1.00 for depression, p = 0.424) although no statistical significance was shown. In the whole study population, anxiety was a significant predictor for depression and vice versa (p < 0.001) with other predictive risk factors for anxiety that were age ≥ 85 years old (odds ratio [OR] 6.14, p = 0.018), female (OR 2.41, p = 0.024), cancer (OR 2.19, p = 0.039) and major surgery (OR 2.39, p = 0.023). Similarly, older patients ≥ 85 years old (OR 10.44, p = 0.003) and female (OR 6.07, p = 0.006) had higher risk for depression. Both anxiety and depression were significant risks for loss of appetite (p = 0.005 and 0.001). Lastly, the fear of disease progression due to rescheduling was more frequent in cancer patients (p = 0.035). CONCLUSION: The mental health and disease burden of older surgical patients should be taken into careful consideration when cases need to be postponed in our healthcare system.

The Impact of COVID-19 on the Functioning of a Neurosurgical Service at a Tertiary Institute in a Low-Resource Setting.

Objective During the COVID-19 pandemic, certain precautionary measures were implemented to limit its effect, including the cancellation of clinics and elective surgical lists. To determine the impact, if any, of the pandemic on the running of a neurosurgical service, an audit was performed on the volume of referrals, admissions and type of surgeries performed at a tertiary institute in a low-resource setting. Methods An audit of the neurosurgical department's database was performed on the number of referrals, admissions, surgical procedures, and types of procedures done at the San Fernando General Hospital. This was divided into two 15-month periods, pre-pandemic (January 1, 2019 to March 31, 2020) and intra-pandemic (April 1, 2020 - June 30, 2021). Results During the pre-pandemic period (January 1, 2019 - March 31, 2020), 2,597 patients were referred to the service and 309 major procedures were performed. Two thousand and forty-two patients were referred during the intra-pandemic (April 4, 2020 - June 30, 2021) period, with 354 surgeries performed. More external ventricular drains (29 vs 50), craniotomies for trauma (73 vs 98), anterior cervical fusion (42 vs 47), lumbar fusions (9 vs 12), ventriculo-peritoneal shunts (16 vs 19) and aneurysm clipping (10 vs 13) were done during the intra-pandemic period. Conclusion Although elective surgical procedures and clinics were reduced, the number of patients seen and total procedures performed did not vary significantly. The neurosurgical pathology encountered remained constant during the pandemic. This shows the importance of maintaining a fully functional neurosurgical service, as we continue to adapt to the COVID-19 pandemic.

A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgical procedures. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional, and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anesthesia, delayed presentation of vascular surgery conditions, and poorer outcomes of patients with chronic limb threatening ischemia. This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.

Operating-Room Procedures Do Not Increase Risk of COVID-19 Infection.

BACKGROUND AND OBJECTIVES: Operating-room procedures canceled due to the COVID-19 pandemic depleted hospital revenue and potentially worsened patient outcomes through disease progression. Despite safeguards to resume elective procedures, patients remain apprehensive of contracting COVID-19 during hospitalization and recovery. We investigated symptomatic COVID-19 infection in patients undergoing operating-room procedures during the spring 2020 outbreak in Fairfield County, CT, a heavily affected New York Metropolitan area. METHODS: We retrospectively analyzed 419 operating-room patients in Danbury and Norwalk Hospitals between 3/16/20 and 5/19/20. COVID-19 infection was assessed through test results or documented well-being within 2 weeks postdischarge. Variables studied were procedure classification, length of stay, and discharge disposition. Postprocedural COVID-19 infection was analyzed using binomial tests comparing rates to state-mandated infection data. RESULTS: Six patients developed COVID-19 after 212 urgent-elective and 207 emergent procedures. Overall postprocedural infection risk was equivalent to community infection risk (P > .05). No infections occurred in 1-2 day stays or urgent-elective procedures with discharge home (both P < .05). Discharges home reduced the risk to one-sixth of community spread (P = .03). Risk of infection doubled in hospitalizations > 5 days (P = .05) and quadrupled in discharges to extended care facilities (P = .01). DISCUSSION: Operating-room procedures did not increase the risk of symptomatic COVID-19 infection during an outbreak. Urgent-elective and emergent procedures during further outbreaks appear safe when anticipating short stays with discharges home. When anticipating prolonged hospitalization or discharges to facilities, appropriate delay of urgent-elective procedures may minimize risk of infection.

Initial assessment of framework for delivery of elective orthopaedic surgery in the United Kingdom following the COVID-19 pandemic.

PURPOSE: In light of the COVID-19 pandemic, a framework for safe provision of elective orthopaedic surgery must be developed in order to restore and maintain activity. The aim of this study was to explore patient attitudes to surgery and theatre efficiency as a result of the COVID-19 pandemic and assess a potential framework for the delivery of such services. METHODS: Prospectively collected data on theatre timings and procedures completed per session used to assess theatre efficiency comparing June 2019 to June 2020. Information on patient compliance with 14-day household isolation and attitudes to surgery were collected prospectively over a seven-week period using a questionnaire. Follow-up data were collected via telephone consultation a minimum of two weeks after discharge. RESULTS: Significant reduction in the number of points per session (p = 0.02) with a mean of 3.19 in 2019 and 2.42 in 2020. Only 18 of 31 patients were compliant with pre-operative isolation with individual failures accounting for four of 13 and failures by household members accounting for nine. Impact of COVID-19 and precautions on patient anxiety was mixed. No patients required symptomatic COVID-19 swab post-operatively. CONCLUSION: With the restrictions of COVID-19, there are significant problems with theatre efficiency, in effect losing an operation a list. Furthermore, compliance with pre-operative isolation was poor but to the best of our knowledge no patients became unwell from COVID-19 post-operatively. Additional strategies will be required to reinstate an effective elective orthopaedic service, especially as the nation heads into another wave.

Public Interest in Elective Urological Procedures in the COVID-19 Pandemic: A Google Trends Analysis.

INTRODUCTION: We sought to characterize public interest in elective urological procedures amid the COVID-19 pandemic, and specifically after the Centers for Medicare and Medicaid Services and the American Urological Association recommended cessation of all nonessential procedures. METHODS: We extracted relative search volumes from Google Trends™ (January 2015 to May 2020) for keywords related to the 4 procedure categories of male infertility, erectile dysfunction, Peyronie's disease and vasectomy. The most popular keywords in each category were used to assess immediate (30 days preceding and following official recommendation from Centers for Medicare and Medicaid Services on March 18, 2020) and long-term (January 1, 2015 to March 18, 2020 vs March 19, 2020 to May 21, 2020) shifts in public interest. Lastly, we assessed geographical variations in public interest during the phase I reopening period from April 24 to May 31, 2020. RESULTS: There was an immediate reduction in interest across all 4 categories following the Centers for Medicare and Medicaid Services recommendation. Long-term post-announcement relative search volume was lower than pre-announcement relative search volume in all categories as well, namely male infertility (54.33% vs 68.74%, p=0.02), erectile dysfunction (45.00% vs 76.74%, p <0.0001), Peyronie's disease (48.33% vs 77.95%, p <0.0001) and vasectomy (51.33% vs 66.73%, p=0.0005). During the phase I reopening period the relative search volume for vasectomy was higher in states that reopened early than in states that reopened late (60.29% vs 50.52%, p=0.029). CONCLUSIONS: Public interest in elective urological procedures decreased following the onset of the COVID-19 pandemic and recommendations from the Centers for Medicare and Medicaid Services. Interest rebounded in May, seemingly driven by states that lifted their stay-at-home order earlier than others.

Optimizing preoperative antibiotics in patients with ß-lactam allergies: A role for pharmacy.

PURPOSE: Patients with a reported ß-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting. METHODS: A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018. RESULTS: Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group. CONCLUSION: Implementation of a pharmacy-driven BLA reconciliation significantly increased ß-lactam preoperative use without negative safety outcomes.

Impact of COVID-19 Pandemic in a Brazilian High-Volume Aortic Center.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented lack of control of what was to come. The intent of this document is to provide a balance of how much was ceased to be done for patients with aortic disease, to assess the mortality of these patients, and to show what happened to those who became COVID-19 positive during their hospitalization. METHODS: From April 1st to July 31st 2020, the worst period of the pandemic in São Paulo, Brazil, the Institute's aortic surgical patients operated on were evaluated and those were compared with patients operated during the same period in 2019. RESULTS: In 2019, 88 surgeries were performed; most of them were elective (66 [75%]), 10 were urgent, and 12 were emergency surgeries. In 2020, during the COVID-19 pandemic, we operated on only 31 patients, being 74.2% non-elective surgeries (P<0,001). There was a higher mortality for patients operated on during the pandemic surge of COVID-19 (P<0,001), but it was not specifically related to infected patients. CONCLUSION: The COVID-19 pandemic had an impact on surgical volume and outcome of patients with aortic disease, although it did not directly increase mortality.

[How to Resume Elective Orthopaedic Surgical Procedures during the COVID-19 Pandemic?] / Como Retomar a Atividade Cirúrgica Eletiva em Ortopedia durante a Pandemia COVID-19?

This document was prepared by the College of Orthopedics of the Portuguese Medical Association with the aim of developing the guidelines on the resumption of elective surgical activity in Orthopedics during the COVID-19 pandemic. It sets the criteria that allow the prioritization of surgeries according to the severity of the clinical situation, based on existing and published classifications. Moreover, it provides an organizational model for patient preparation and describes the patient pathways in the preoperative, intraoperative and postoperative periods. It also describes safety rules for elective surgery and a model for monitoring patients after discharge according to scientific evidence.

Este documento foi elaborado pelo Colégio de Ortopedia da Ordem dos Médicos com o objetivo de estabelecer as orientações sobre a retoma da atividade cirúrgica programada em Ortopedia durante a pandemia COVID-19. As presentes normas de orientação: a) definem os critérios que permitem a priorização das cirurgias de acordo com a gravidade da situação clínica, com base em classificações existentes e publicadas; b) fornecem um modelo de organização para a preparação dos doentes, descrevendo os circuitos do doente nos períodos pré-operatório, intraoperatório e pós-operatório; c) realçam as regras de segurança para a realização de cirurgias e desenham um modelo de acompanhamento após a alta de acordo com a evidência científica.

Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening.

BACKGROUND: The COVID-19 pandemic has necessitated the adoption of protocols to minimize risk of periprocedural complications associated with SARS-CoV-2 infection. This typically involves a preoperative symptom screen and nasal swab RT-PCR test for viral RNA. Asymptomatic patients with a negative COVID-19 test are cleared for surgery. However, little is known about the rate of postoperative COVID-19 positivity among elective surgical patients, risk factors for this group and rate of complications. METHODS: This prospective multicenter study included all patients undergoing elective surgery at 170 Veterans Health Administration (VA) hospitals across the United States. Patients were divided into groups based on first positive COVID-19 test within 30 days after surgery (COVID[-/+]), before surgery (COVID[+/-]) or negative throughout (COVID[-/-]). The cumulative incidence, risk factors for and complications of COVID[-/+], were estimated using univariate analysis, exact matching, and multivariable regression. RESULTS: Between March 1 and December 1, 2020 90,093 patients underwent elective surgery. Of these, 60,853 met inclusion criteria, of which 310 (0.5%) were in the COVID[-/+] group. Adjusted multivariable logistic regression identified female sex, end stage renal disease, chronic obstructive pulmonary disease, congestive heart failure, cancer, cirrhosis, and undergoing neurosurgical procedures as risk factors for being in the COVID[-/+] group. After matching on current procedural terminology code and month of procedure, multivariable Poisson regression estimated the complication rate ratio for the COVID[-/+] group vs. COVID[-/-] to be 8.4 (C.I. 4.9-14.4) for pulmonary complications, 3.0 (2.2, 4.1) for major complications, and 2.6 (1.9, 3.4) for any complication. DISCUSSION: Despite preoperative COVID-19 screening, there remains a risk of COVID infection within 30 days after elective surgery. This risk is increased for patients with a high comorbidity burden and those undergoing neurosurgical procedures. Higher intensity preoperative screening and closer postoperative monitoring is warranted in such patients because they have a significantly elevated risk of postoperative complications.

Changes in percutaneous coronary intervention practice in Japan during the COVID-19 outbreak: LIFE Study.

AIM: The global outbreak of coronavirus disease (COVID-19) has had widespread effects on clinical practice, and is reportedly associated with reduced percutaneous coronary intervention (PCI) rates in the US and Italy. This study aimed to ascertain the influence of the COVID-19 outbreak on PCI practice in Japan. METHODS: In a retrospective analysis of claims data from National Health Insurance and Later-Stage Elderly Healthcare System enrollees in Kobe City, Japan, we examined the changes in PCI incidence before and during the COVID-19 outbreak. Percutaneous coronary intervention incidence during the COVID-19 outbreak in 2020 was compared with that of the same (pre-outbreak) period in 2019 using a Poisson regression analysis with the monthly number of PCIs as the dependent variable. RESULTS: A total of 639 patients underwent PCI in Kobe City between February and May 2020. The results showed a 19% reduction in all PCI procedures during the outbreak relative to the pre-outbreak period (P = 0.001). There were no significant changes in non-elective PCIs for acute coronary syndrome (ACS) cases, but a 25% reduction in elective PCIs for non-ACS cases (P < 0.001). CONCLUSIONS: The COVID-19 outbreak was associated with a decline in elective PCIs for non-ACS cases, but did not appear to influence non-elective PCIs for ACS cases in Japan.

Planning and analysing 'Green' post-COVID-19 orthopaedic perioperative recovery pathway.

The effect of the severe acute respiratory syndrome coronavirus 2 pandemic on the National Health Service in the United Kingdom has been profound and unprecedented with suspension of most elective surgeries. As we are emerging from lockdown now, restarting elective surgical procedures in a safe and effective manner is an expected challenge. Many perioperative factors including patient prioritisation, risk assessment, health infrastructure and infection prevention strategies need to be considered for patient safety. The British Orthopaedic Association, along with the National Health Service, have provided recent guidelines for restarting non-urgent and orthopaedic care in the United Kingdom. In this article we review the current guidelines and literature to provide some clarity for clinical practice.

Is it safe yet? Patient readiness and perceptions about returning to hospital for planned orthopaedic care.

INTRODUCTION: COVID-19 has necessitated significant changes to healthcare delivery but little is known regarding patient opinions of risks compared with benefits. This study investigates patient perceptions concerning attendance for planned orthopaedic surgery during the COVID-19 pandemic. MATERIALS AND METHODS: A total of 250 adult patients from the elective orthopaedic waiting list at Cardiff and Vale University Health Board were telephoned during lockdown. They were risk stratified for COVID-19 based on British Orthopaedic Association guidance and a discussion was held to determine patient willingness to proceed with surgery. The primary outcome measure was patients' willingness to proceed. RESULTS: Of the total number telephoned, 196 patients were included in the study, with a mean age of 57.4 years; 129 patients were willing to attend for surgery, leaving over one-third wishing to cancel or defer. The most frequent reason given for not wishing to attend was fear of contracting COVID-19. There was a statistically significant difference in the willingness to proceed observed with increasing clinical risk (χ2(3) = 50.073, p = .000) with almost double the expected count of unwilling to proceed in the high and very high risk groups, equalled by half the expected count in the low risk group. DISCUSSION: This study illustrates the variable and personal decisions that patients are making about orthopaedic care because of COVID-19. It highlights the need for change to departmental processes regarding recommencement of planned surgical lists. It also reconfirms the importance of regular communication and shared decision making between a well-informed patient and a holistic orthopaedic team.

Provision of Surgical Services to COVID-19-Infected Patients at a Tertiary Care Center in Pakistan: A One-Year Clinical Review of the Year 2020 in General Surgery Department.

Background and objectives The frequency of COVID-19-positive or suspicious patients grew steadily, and these patients were received in emergency and outpatient departments at an unprecedented pace for the need of an elective or emergent surgical assessment. We conducted this survey to document the number of surgeries performed on COVID-19-positive patients during the ongoing pandemic at a tertiary care center in Pakistan. Materials and methods A retrospective clinical audit was conducted in a tertiary care hospital that receives surgical cases from almost all over the country. Ethical approval was granted prior to the execution of this intra-departmental audit. Both patients who were admitted to general surgery and visited on a consultative basis in other departments during the year 2020 were evaluated, and only those having COVID-19 polymerase chain reaction (PCR)-positive were included. Those with PCR-negative were omitted from the analysis. All the surgical procedures performed in these patients, along with those managed conservatively, were analyzed. Basic and demographic data of all patients were collected from electronic medical records. The data were defined as either mean and standard deviation or frequency and relative percentages. The normality of the data was verified by the Shapiro-Wilk test. Parametric analysis was used to interpret the disparity in descriptive statistics. Although the categorical results were compared by cross-tabulation, the degrees of significance were calculated either by chi-square test or Fisher's exact test according to the distribution of the data. A p value of less than 0.05 was considered significant (two-tailed). Results A total of 79 COVID-19-positive patients were provided with surgical services and subsequently analyzed. The mean age of those patients was 48.88 ± 16.62 years. The mean length of stay in the hospital was 2.10 ± 3.52 with indifference among gender and mode of treatment (either surgical or conservative). The study participants were 59.5% males and 40.5% females, and only 6.3% had a past surgical history. Most patients were admitted through the outpatient department (65.8%), and only a few were referrals from other departments (10.1%); 64.5% of patients were managed in general wards, 24.0% in critical care units, and 11.4% in intensive care units. Surgical intervention was done in 60.8% of the COVID-19-positive patients, while the rest 39.2% were conservatively managed. Among whom, 63.3% were discharged, 29.1% of them left against medical advice (LAMA), with a 7.6% death rate during the hospital stay. The frequent comorbidities were diabetes (27.8%) and hypertension (26.6%), although most patients had no comorbidities (49.3%). Symptomatic gall stones were the most frequent reason for surgical admission in COVID-19-positive patients, while the most frequent surgical intervention performed was laparoscopic cholecystectomy. Males were comparatively managed more frequently by surgical intervention and females been more conservatively managed (p = 0.037). Out of the six mortalities, five were surgically managed. Seventy seven percent of the surgically managed patients were discharged, and the majority of LAMA patients were being conservatively managed (p < 0.001). Conclusion This study was done to analyze the demographic factors associated with the outcomes of surgical interventions performed on COVID-19-positive patients.