Impact of Covid 19 Pandemic on Elective Rectal Cancer Surgery - Single Institution Experience

Introduction: Surgical treatment of rectal cancer depends on clinical stage, size and location of primary tumor. A sphincter preserving technique such as low anterior resection (LAR) is the preferred method if negative distal margin can be achieved. If an adequate distal margin cannot be obtained, an abdominoperineal resection (APR) is required. A proctosigmoidectomy (Hartmann's procedure) is performed in patients with potentially curable obstructing rectal cancer after neoadjuvant chemoradiotherapy, or as a palliative treatment for locally advanced rectal cancer. Aim(s): The aim of this retrospective study was to investigate the impact of COVID 19 pandemic on the number and type of surgeries performed for the treatment of rectal cancer in UHC Zagreb, Department of Surgery. Material(s) and Method(s): Collected data were extracted from medical records of the patients who underwent surgery at the Department of Surgery from 1st of January 2016 to 31st of December 2022 with prior Ethics Committee approval. Total of 688 patients were included. Retrospective analysis of number and type of surgery was done consecutively by years for the period of interest. Result(s): In 2016 total of 75 patients underwent elective surgery for rectal cancer. LAR was performed in 64% (N=48) of patients, Hartmann's procedure in 20% (N=15), and APR in 16% (N=12). In 2017, 94 surgeries were performed. LAR accounted for 64% (N=60), Hartmann's procedure 17% (N=16), and APR 19% (N=18). In 2018, 115 surgeries were performed. LAR accounted for 69% (N=79), Hartmann's procedure 10% (N=12), and APR 21% (N=24). In 2019, 80 surgeries were performed. LAR accounted for 67% (N=54), Hartmann's procedure 9% (N=80), and APR 24%. In 2020, 78 surgeries were performed. LAR accounted for 59% (N=46), Hartmann's procedure 14% (N=11), and APR 27% (N=21). In 2021, 124 surgeries were performed. LAR accounted for 66% (N=82), Hartmann's procedure 14% (N=17), and APR 20% (N=25). In 2022, 122 surgeries were performed. LAR accounted for 64% (N=78), Hartmann's procedure 15% (N=18), and APR 21% (N=26). Conclusion(s): Our results show steady growth in numbers of performed surgeries in the years prior to the pandemic, with exception of the year 2019 when our department underwent organizational changes. In 2020, significant decrease in number of surgeries was observed as a result of restrictive epidemiological measures established to reduce the spread of COVID 19 infection. COVID 19 pandemic measures also resulted in delayed diagnosis and treatment of rectal cancer which is indirectly shown through the increasing share of Hartmann's procedure. In the years following the relaxation of measures, significant increase in number of performed surgeries that exceeded all the pre-pandemic years was recorded. Constant elevated share of Hartmann's procedure was noted as possible consequence of post COVID delay in diagnosis and confirmation of rectal cancer in more advanced stages of disease.

The Impact of COVID-19 on Surgical Disease

The impact of COVID-19 on surgical disease has been transformative. The complete extent of its impact is unlikely to be fully understood for decades to come. New surgical disease processes, many still being elucidated, have emerged as both a direct result of COVID-19, as well as sequelae from the pathophysiologic response to the disease. The most notable consequences include hypercoagulability due to COVID-19 as well as a predilection for gastrointestinal tract pathology. The perioperative sequelae of the novel COVID-19 virus on surgical disease remain unknown, but evidence suggests this disease increases perioperative risk. Perhaps just as concerning, are the economic impacts and paradigm altering consequences that have been felt. Elective surgeries ground to a halt, trauma activations experienced sharp upswings and downswings, and visits to doctors in general have taken a sharp downturn. This has led to delays in diagnosis and treatment, increases in morbidity and mortality, and dramatic changes in how surgical services around the world are run. This global pandemic will forever change how surgery is practiced and shape our profession for decades to come. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Management of the Surgical Patient during the First and Second Wave of COVID-19 Pandemic: Experience of a Tertiary Care Centre

Objective: Due to the COVID 19 pandemic healthcare providers all over the world had brought some changes in the management of surgical patients. This study is aimed to estimate the impact of pandemic on surgical practices. Material(s) and Method(s): We conducted a retrospective review of the medical records of all patients admitted to the department of general surgery (both elective & emergency), SCB Medical College and Hospital, Odisha, India from April 1 to July 31, 2020, and 2021 and the records were those of patients who were admitted in the same period in 2019. Data collection includes the number of admissions, the reason for admission, the age & gender of the patients admitted patients and type of management. Result(s): There was a 57.5% reduction in total admission during first COVID in pandemic 2020 and 58.7% reduction during second wave of pandemic in 2021. The proportion of patient presenting to emergency department was more in 2020 and 2021 than 2019. Number of emergency admission decreased by 46.54% in 2020 and 46% in 2021. There was a 79.5% drop in the number of out-patients admission in 2020 and 84% in 2021. Furthermore a 79.8% reduction in elective surgical intervention noticed in 2020 and 80% in 2021. Conservative management was preferred over surgical management during the COVID era. Conclusion(s): COVID-19 has led to a drastic reduction in outpatient and elective surgical practices. Hence creating a major concern for all surgeons about the critical situation.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

COVID-19- A Challenge for Urology Subspecialty in an overwhelmed public sector hospital: A Descriptive Review of Urology Department, Lady Reading Hospital

Background: COVID-19 has brought unprecedented changes in every aspect of life throughout the world including the healthcare delivery system. After a grinding halt in surgical practice due to this pandemic, the conventional protocols needed a thorough overhaul before kick-starting formal services. This study discusses ways and procedure changes adopted at the Urology department to navigate this crisis and extend adequate urological care to patients at the same time. Aim(s): To share our experience of patient management in the era of the COVID-19 pandemic. Method(s): It's a descriptive review article based on patient management protocols and clinical audit in the era of COVID-19 pandemic at the Departmentof Urology, MTI, Lady Reading Hospital from 20th Marchto 20th June 2020. Clinical implication the benefit of this study is how to organize things and continue health care provision in a deadly pandemic. Furthermore, it will set a precedence that how to cope with such a pandemic in the future. Conclusion(s): All surgical patients should be screened for COVID-19, with preference given to PCR tests. All elective surgeries should be put on hold as a result of the limited availability of ventilators, manpower, and hospital beds. Only semi-elective, lifesaving and oncologic surgeries that cannot be delayed should be done with full PPEs provided to every personnel frequenting operating theaters during the procedure. Furthermore, more efforts are needed to lift the infrastructure of hospitals and make them capable to face problems of such proportions in the future.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

General Surgery Resident Case Numbers During the Covid-19 Pandemic

Introduction: The COVID-19 pandemic has had widespread effects on the healthcare system. For trainees, one particular detriment has been the cancellation of elective operations, reducing clinical experience and procedural volumes. Measures instituted to combat the pandemic have resulted in decreased cancellation of elective cases to varying degrees. The aim of this study is to evaluate the ongoing effect of the pandemic on resident operative volume. Method(s): Operative case numbers of general surgical graduates in 2019, 2020, and 2021 were extracted from the Accreditation Council for Graduate Medical Education case logs. Data included mean total cases/graduate and means for individual case types. Data was considered by overall number of cases and cases performed as surgeon chief. Analysis of variance was employed to compare groups with p<0.05 considered significant. Result(s): Mean total major cases differed significantly among groups with reduced volume noted for 2020 graduates but no difference in volume between 2019 and 2021 graduates (1070.5+/-150 vs 1054.8+/-155 vs 1074.1+/-164, p=0.0041). This same pattern was noted for surgeon chief total cases (288.6+/-69 vs 264.4+/-67 vs 286.2+/-73, p<0.0001) as well as several major general surgery subcategories including cases involving the stomach, small intestine, large intestine, biliary system, among others. Conclusion(s): Despite continued reduction in and alteration of elective surgery practice, improved pandemic measures have allowed for increased surgical volume. This has translated to increased operative experience for graduating surgical trainees that are comparable to case numbers that preceded the pandemic. Ramifications for the 2020 graduating cohort as well subsequent cohorts require continued evaluation.

Implementation of Clean Hospital Strategy and Prioritizing Covid-19 Prevention Factors Using Best-Worst Method.

Many nations have suffered the catastrophe of COVID-19, and one of the first countries affected by the pandemic was Iran; all industries and individuals have been adversely affected by the pandemic. Health care systems and patients' conditions, in particular, were disrupted due to canceling elective surgery. To put it more sharply, a delay in performing elective surgery may potentially impact patients' survival and the quality of their lives. To cope with the new situation, in the first stage, the Clean Hospital strategy was proposed in order to minimize the effects of this pandemic on elective surgical services. The mentioned strategy is a try to provide a solution and resume elective surgeries in the pandemic period. In the second stage, panel discussion, Delphi method, and the best-worst method (BWM) were employed to prioritize the factors that inhibit Coronavirus transmission. The proposed strategy and the results of this study could be used by policymakers and health departments to resume elective surgeries and control the infection to maintain a hospital or a section of it clear. The overall result of the study showed that the most important Covid-19 prevention factors in Clean Hospitals were personal protection (w = 0.212), screening checklist (w = 0.182), and check body temperature (w = 0.126), respectively (C1 > C2 > C3). According to the financial, time, and human resource limitations, first, resources were allocated to higher priority criteria, and in order of priority, all items (C1, C2, …., C9) were used in the Clean hospital strategy.

Groin Hernia Repair during the COVID-19 Pandemic-A Romanian Nationwide Analysis.

Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusions: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.

Establishing a COVID-secure site for elective surgery during the COVID pandemic: An observational study.

INTRODUCTION: Maintaining timely and safe delivery of major elective surgery during the COVID-19 pandemic is essential to manage cancer and time-critical surgical conditions. Our NHS Trust established a COVID-secure elective site with a level 2 Post Anaesthetic Care Unit (PACU) facility. Patients requiring level 3 Intensive Care Unit admission were transferred to a non-COVID-secure site. We investigated the relationship between perioperative anaesthetic care and outcomes. MATERIALS AND METHODS: All consecutive patients undergoing major surgery at the COVID-secure site between June and November 2020 were included. Patient demographics, operative interventions and 30-day outcomes were recorded. Multivariate logistic regression was used to determine the odds ratio of outcomes according to PACU length of stay and the use of spinal or epidural anaesthesia, with age, sex, malignancy status and American Society of Anesthesiologists grade as independent co-variables. RESULTS: There were 280 patients. PACU length of stay >23h was associated with increased 30-day complications. Epidural anaesthesia was associated with PACU length of stay >23h, increased total length of stay, increase hospital transfer and 30-day complications. Two patients acquired nosocomial COVID-19 following hospital transfer. DISCUSSION: Establishing a separate COVID-secure site has facilitated delivery of major elective surgery during the COVID-19 pandemic. Choice of perioperative anaesthesia and utilisation of PACU appear likely to affect the risk of adverse outcomes.

Efficiency estimation on the use of elective surgical theaters in the Chilean public health system from 2018 to 2021

OBjECTivE The efficient use of wards intended for elective surgeries is essential to resolve cases on the surgical waiting list. This study aims to estimate the efficiency of ward use in the Chilean public health system between 2018 and 2021.METHoDS The design was an ecological study. Section A.21 of the database constructed by the monthly statistical summaries that each public health network facility reported to the Ministry of Health between 2018 and 2021 was analyzed. Data from subsections A, E, and F were extracted: ward staffing, total elective surgeries by specialty, number, and causes of cancelation of elective sur-geries. Then, the surgical performance during working hours and the percentage of hourly oc-cupancy for a working day was estimated. Additionally, an analysis was made by region with data from 2021.RESulTS The percentage of elective wards relative to staffed wards ranged from 81.1% to 94.1%, while those enabled in relation to staffed wards ranged from 70.5% to 90.4% during 2018 and 2021. The total number of surgeries was highest in 2019 (n = 416 339), but for 2018, 2020, and 2021 it ranged from 259 000 to 297 000. Cancelations ranged between 10.8% (2019) and 6.9% (2021), with the leading cause being patient-related. When analyzing the number of cases canceled monthly by facility, we saw that the leading cause was trade union-related. The maximum throughput of a ward intended for elective surgery was reached in 2019 with 2.5 surgeries;in 2018, 2020, and 2021, the throughput was around two surgeries per enabled ward for elective surgery. The percentage of ward time occupied during working hours as compared to a contract day ranged from 80.7% (2018) and 56.8% (2020). CoNCluSioNS All the parameters found and estimated in this study show an inefficient utilization of operating rooms in Chilean public healthcare facilities.

Evaluation of Factors Causing a Delay in Management and Hospital Stay in Diabetic Foot Amputation Patients: A Prospective Cohort Study

OBJECTIVE: To determine the rate of different amputation levels in diabetic foot patients and the incidence of repetitive foot surgeries and evaluate the factors causing a delay in hospital stay and amputation of patients. METHODOLOGY: This prospective cohort study was conducted in Dr. Ruth K.M. Pfau, Civil Hospital Karachi, Pakistan. The study selected 375 participants from the clinic's daily patient inflow from October 2021 to March 2022 using a non-probability consecutive sampling technique. Those who had a delay in hospital stay and amputation were further followed up from May-October 2022. The chi-square test and Kruskal Wallis test (p-value <0.05) were used to correlate the effect of the level of lower limb amputation and the cause of delay in amputation using SPSS version 24.0. RESULT(S): Total 246(65.60%) were males and 129(34.40%) were females. Toe amputation was the most commonly seen amputation in 173(46.1%) participants. About 168(44.8%) patients had some in-hospital delay stay during their treatment. Preoperative hurdles (Uncontrolled RBS, Osteomyelitis, etc.) were the most common factor causing an in-hospital delay in 92(24.5%) patients. The level of amputation performed was found to be statistically significant with factors causing a delay in hospital stay through chi-square (p=0.003*) and Kruskal Wallis test H (2) statistic= 13.3, df = 3, H (2), P=0.004*). CONCLUSION(S): Diabetic foot is a frequent cause of amputation globally, majorly in developing countries like Pakistan. On-time provision of treatment to these patients can decline the global amputation rate due to diabetic foot ulcers.Copyright © 2023 Syeda Anjala Tahir.

Factors related to mortality in geriatric patients after elective surgery: a retrospective cohort study

Introduction: The increased number of surgery on the elderly is often followed by an increased risk of mortality rate. Identifying the risk factors of surgical death in elderly patients will be mandatory before making a decision. This study aimed to determine mortality-associated factors in older people who underwent inpatient elective surgery. Methods: This cohort retrospective study analyzed secondary data from the medical records of geriatric patients hospitalized at Dr. Kariadi Hospital Semarang in 2020. Patients aged ≥ 60 years and who have undergone elective surgery were included. Patients with incomplete medical records, who had undergone outpatient surgery, more than one surgery, and emergency surgery, Covid-19, were excluded. A total of 382 patients met the criteria. In this study, independent variables analyzed were age, sex, nutritional status based on body mass index, functional status by Barthel, marital status, residence status, number of comorbidities according to Charlson Comorbidity Index, albumin levels, electrocardiogram (ECG) abnormalities, surgery type, and American Society of Anesthesiologists (ASA) status. The dependent variable was in-hospital mortality. In the logistic regression analysis, we identified the five most significant variables to allow for the prediction of in-hospital mortality. Results: Residence status (p= 0.003), ECG (p= 0.001), comorbidity (p <0.0001), albumin status (p< 0.0001), and ASA status (p< 0.0001) were identified as factors that affect postoperative mortality after multivariate analysis. Conclusion: In this study, mortality-associated factors were living alone, ECG abnormality, comorbidity > 2, hypoalbumin, and ASA > 2. © 2023, Sanglah General Hospital. All rights reserved.

The Relationship Between Public Interest and Surgical Demand During the COVID-19 Pandemic.

INTRODUCTION: Surgical databases are useful for examining outcomes and case volume to improve care, while public interest data has the potential to track the supply and demand of medical services in specific communities. However, the relationship between public interest data and case volume from surgical databases, specifically during disruptive instances like the coronavirus pandemic, is unknown. Therefore, the purpose of this study is to determine how public interest data is related to the case volume of coronavirus and other surgical procedures performed during the coronavirus pandemic. METHODS: This retrospective study included a review of appendectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) cases from the National Surgery Quality Improvement Project and relative search volume (RSV) of hip replacement, knee replacement, appendicitis, and coronavirus from Google Trends from 2019 to 2020. T-tests were used to compare surgical caseload and RSV data before and after the COVID-19 surge in March 2020, while linear models were used to determine relationships between confirmed procedures and relative search volumes. RESULTS: The RSV for knee replacement (p < 0.001, Cohen's D [d] = -5.01, 95% confidence interval [CI]: -7.64 to -2.34) and hip replacement (p < 0.001, d = -7.22, 95% CI: -10.85 to -3.57) had a large dip during the coronavirus pandemic, while the RSV for appendicitis had a smaller dip (p = 0.003, d = -2.37, 95% CI: -3.93 to -0.74). Linear models showed very strong linear relationships between surgical RSV and surgical volume for TKA (R2 = 0.931) and THA (R2 = 0.940). CONCLUSIONS: There was a significant reduction in the number of elective surgeries, which correlated to drops in public interest during COVID-19. The strong correlations between RSV, surgical volume, and coronavirus cases indicate that public interest can be used to track and predict surgical case volume. Our findings allow for greater insight into the use of public interest data to gauge surgical demand.

Reducing last-minute cancellations of elective urological surgery-effectiveness of specialist nurse preoperative assessment.

Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic. A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of 'lead-in' antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimized, and vacant slots were backfilled. A new guideline was created to improve the timing and structure of the generic preassessment. Between 1 January 2021 and 30 June 2021, a mean of 40 cases was booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 1 July 2021, cancellations fell to 4/124 (3%) for the month. On re-audit, there was a sustained and statistically significant reduction in cancellation rates: between 1 July 2021 and 31 December 2021 cancellations averaged 4.2/97.5 (4.3%, P < .001). Two to nine (2%-16%) patients were started on antibiotics each month, while another zero to two (0%-2%) were contacted for other reasons. The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.

Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

Aims The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. Methods This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from wait-ing lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five -dimension questionnaire (EQ- 5D) and visual analogue scores (EQ- VAS), Rockwood Clini-cal Frailty Scale (CFS), and 36 -Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ- 5D of less than zero. Results There were significant deteriorations in the EQ- 5D (mean 0.175, 95% confidence inter- val (CI) 0.145 to 0.204;p < 0.001), EQ- VAS (mean 8.6, 95% CI 7.0 to 10.4;< 0.001), and CFS (from 3 "managing well" to 4 "vulnerable";p < 0.001), and a significant increase in the number of those in a state that was WTD (n = 48;p < 0.001) during the previous six months for the whole cohort. A total of 110 patients (33.7%) stated that their health was much worse and 107 (32.8%) felt it was somewhat worse compared with six months previously. A significantly greater EQ- 5D (-0.14, 95% CI 0.08 to 0.28;p = 0.038) and a state that was not WTD (-0.14, 95% CI 0.01 to 0.26;p = 0.031) were associated with a deterioration in the EQ- 5D. THA (0.21, 95% CI 0.07 to 0.34;p = 0.002) or a lower (better) CFS (0.14, 95% CI 0.07 to 0.20;p < 0.001) were independently significantly associated with a deterioration in the CFS. Conclusion Patients waiting more than six months for THA or KA had a significant deterioration in their HRQoL and increased frailty, with two-thirds of patients feeling that their health had worsened.

Practice Changing Updates in Perioperative Medicine Literature 2022. A Systematic Review.

Perioperative medicine is a rapidly growing multidisciplinary field with significant advances published each year. In this review, we highlight important perioperative publications in 2022. A multi-database literature search from January to December of 2022 was undertaken. Original research articles, systematic reviews, meta-analyses, and guidelines were included. Abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature were excluded. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont, Canada). A modified Delphi technique was used to identify 8 practice-changing articles. We identified another 10 articles for tabular summaries. We highlight why these articles have the potential to change clinical perioperative practice and areas where more information is needed.

COVID-19 screening in asymptomatic patients scheduled for surgery. What is the role of rt-PCR in elective procedures during the pandemic?

Background: COVID-19 has changed medical practice nowadays. One of the biggest concerns has been establishing when invasive procedures such as surgery, GI endoscopy or bone marrow transplant are safe;and if it is necessary to consider screening for asymptomatic patients. Method(s): We identified asymptomatic patients that were scheduled for invasive procedures from May 2020 to April 2021 at Clinica de Marly. Patients were asked to fill a questionnaire about GI and upper respiratory symptoms and contact with possible/confirmed cases of COVID- 19 in the last 15 days. Patients taken to emergency procedures, who had symptoms or contact with probable/confirmed cases in the last 15 days were excluded. rt-PCR was performed to screen COVID-19. Result(s): A total of 1837 patients were included. 104 rt-PCRs tested positive for SARS-CoV-2, leading to a 5.66% of identified asymptomatic patients. Patients were followed-up on the 30th day after the procedure. 1733 negative patients responded to our follow-up, in which only 1 death and 2 complications were detected. 102 positive patients were followed-up and no complications or deaths were reported. Conclusion(s): We found the presence of 5.66% of asymptomatic patients with positive rt-PCR for COVID-19. Safe screening will decide if these invasive interventions can be postponed, or, if the benefit outweighs the risks.Copyright © 2022 Asociacion Colombiana de Infectologia. All rights reserved.

EE175 Budget Impact Assessment of Knee Orthoses Funding in Patients With Osteoarthritis of the Knee Considering Total Knee Reconstructive Surgery: Private Australian Payer Perspective

Objectives: To determine the budget impact if knee orthoses were funded for patients with severe osteoarthritis (OA) of the knee from a private Australian payer perspective. Method(s): The ISPOR Principles of Good Practice were used to guide a budget impact analysis comparing the use of knee orthoses to delay total knee reconstruction (TKR) versus the current environment. Delayed TKR was estimated based on a systematic review of electronic databases and a web-based search. Utilisation for TKR (sourced from Australian Medical Benefits Schedule statistics) was projected over the time horizon (2023 to 2027). The clinically eligible (i.e., target) population was based on the proportion of patients with OA of the knee in a large US cohort (N=8,002) deemed to have had TKR prematurely. The cost of TKR was based on Australian hospital separation data. Result(s): Funding of knee orthoses was associated with a cost-saving of $AUD122 to $AUD126 million over a 5-year time horizon based on device costs of $AUD500 and $AUD395, respectively. The cost-savings were primarily driven by 18,000 delayed TKR procedures. Knee orthosis, such as the Thuasne OA, were also associated with improvements in clinical outcomes including pain-free walk distance, pain during exercise, and lequesne index score (P<0.005). Conclusion(s): The widespread prevalence of COVID-19 has disrupted the capacity for Australian hospitals to undertake elective surgeries. The median wait-list time for TKR, which accounted for 47,000 surgeries in 2020-2021, increased from 223 to 308 days in Australia between 2019-2020 to 2020-2021. Our research indicates that the funding of appropriate knee orthoses in patients with severe OA has a cost-saving budget impact while offering potential clinical improvement for patients and reduced pressure on elective surgery wait lists.Copyright © 2022

A reinforcement learning-based optimal control approach for managing an elective surgery backlog after pandemic disruption.

Contagious disease pandemics, such as COVID-19, can cause hospitals around the world to delay nonemergent elective surgeries, which results in a large surgery backlog. To develop an operational solution for providing patients timely surgical care with limited health care resources, this study proposes a stochastic control process-based method that helps hospitals make operational recovery plans to clear their surgery backlog and restore surgical activity safely. The elective surgery backlog recovery process is modeled by a general discrete-time queueing network system, which is formulated by a Markov decision process. A scheduling optimization algorithm based on the piecewise decaying [Formula: see text]-greedy reinforcement learning algorithm is proposed to make dynamic daily surgery scheduling plans considering newly arrived patients, waiting time and clinical urgency. The proposed method is tested through a set of simulated dataset, and implemented on an elective surgery backlog that built up in one large general hospital in China after the outbreak of COVID-19. The results show that, compared with the current policy, the proposed method can effectively and rapidly clear the surgery backlog caused by a pandemic while ensuring that all patients receive timely surgical care. These results encourage the wider adoption of the proposed method to manage surgery scheduling during all phases of a public health crisis.