Prioritizing rapid COVID-19 testing in emergency general surgery patients decreases burden of inpatient hospital admission.

Objectives: The COVID-19 pandemic has changed delivery of emergency general surgery (EGS) and contributed to widespread bed shortages. At our institution, rapid testing is not routinely approved for EGS patients. We examined common EGS conditions (appendicitis and acute cholecystitis), hypothesizing that necessity of testing for COVID-19 significantly delayed operative intervention. Methods: We performed a prepost study to examine a 2-month timeframe, or historical control, prior to COVID-19 testing (January 1, 2020-March 1, 2020) as well as a 2-month timeframe during the COVID-19 era (January 1, 2021-March 1, 2021). We chose conditions that are frequently treated surgically as outpatient or observation status. We examined time for COVID-19 test to result, and associated time to operative intervention (operating room (OR)) and need for admission. Results: Median time to COVID-19 test results was 7.4 hours (IQR 5.8-13.1). For appendectomy, time to surgical consultation or case request did not differ between cohorts. Time to OR after case request was significantly longer (12.5 vs 1.9 hours, p<0.001) and patients more frequently required admission prior to operative intervention if receiving treatment in the COVID-19 timeframe. Similarly, for cholecystectomy there were no differences in time to surgical consultation or case request, but time to OR after case request was longer in the COVID-19 era (21.1 vs 9.0 hours, p<0.001). Conclusion: While COVID-19 positivity rates have declined, the purpose of this study was to reflect on one element of our hospital system's response to the COVID-19 pandemic. Based on our institutional experience, waiting for COVID-19 test results directly impacts time to surgery, as well as the need for admission for a historically outpatient procedure. In the future, if the healthcare system is asked to respond to another pandemic or similar situation, expediting time to OR to eliminate unnecessary time in the hospital and non-critical admissions should be paramount. Level of evidence: Level III, prognostic/epidemiological.

Practice patterns in the management of pediatric iliofemoral arterial thrombosis.

BACKGROUND: Acute arterial thrombosis can be life- and limb-threatening. Most pediatric patients with iliofemoral arterial thrombosis are treated successfully with medical therapy; however, expert consensus is limited, and many recommendations are based on the extrapolation of adult data. We aim to understand treatment patterns and long-term outcomes after pediatric acute iliofemoral arterial thrombosis, from which management recommendations can be informed. METHODS: A single-institution retrospective study of pediatric patients diagnosed with iliofemoral arterial thrombosis from 2009 to 2018 was performed. Multiple parameters of management and follow-up were evaluated. Children anticoagulated for ≤28 days versus >28 days were compared. Data analysis used Fisher exact and Mann-Whitney U tests. RESULTS: Two hundred thirty-six children were included. Median age at diagnosis was 65 days (interquartile range 17-163), with 207 diagnosed as infants, 15 diagnosed between 1 to 2 years, and 14 diagnosed between 2 to 16 years. The median treatment duration was 28 days (interquartile range 13-42); patients treated for >28 days had a longer time for thrombus resolution, and more follow-up ultrasounds were performed. Limb length discrepancy did not differ between the groups (1.0% vs 6.3%, P = .06), and no patients were documented to have developed peripheral arterial disease over a median 6.5-year follow-up. Multiple treatment strategies were employed, the most common being heparin bridged to enoxaparin (25.0%) and enoxaparin monotherapy (21.6%). Eight patients (3.4%) underwent surgical intervention. CONCLUSION: Pediatric iliofemoral arterial thrombosis is primarily a disease of infants treated adequately with heparin or enoxaparin, infrequently requires surgical intervention, and is rarely associated with long-term complications. When guided by thrombus resolution on ultrasound, a four-week or shorter course of anticoagulation does not increase the need for surgical intervention or long-term complications.

Mosquito Vector Production across Socio-Economic Divides in Baton Rouge, Louisiana.

We investigated the role of socio-economic factors in the proliferation of mosquito vectors in two adjacent but socio-economically contrasting neighborhoods in Baton Rouge, LA, USA. We surveyed mosquito larvae habitat, mosquito larvae, and adult mosquitoes during the summer of 2020. We also evaluated the number of requests for mosquito abatement services in the years preceding the study for each area. While we did not find differences in terms of the most abundant species, Culex quinquefasicatus (F1,30 = 0.329, p = 0.57), we did find a higher abundance of mosquito habitats, particularly discarded tires, as well as larvae (z = 13.83, p < 0.001) and adults (F1,30 = 4.207, p = 0.049) of the species Aedes albopictus in the low-income neighborhood. In contrast, mosquito abatement requests were significantly higher in the high socio-economic neighborhood (z = -8.561, p < 0.001). This study shows how factors such as adjudicated properties, discarded tires and pest abatement requests can influence the abundance of mosquito vectors, disproportionately affecting low-income groups. This study also highlights how Aedes spp. may be better indicators than Culex spp. of socio-economic differences between nearby neighborhoods, due to their short flight range and habitat preferences, and this should be considered in future studies attempting to detect such disparities in the future.