The impact of acute surgical unit rostering on National Emergency Access Targets during the COVID-19 pandemic: a single hospital experience.

BACKGROUND: Surgical departments have been dramatically impacted by the novel coronavirus 19 (COVID-19) pandemic, with the cancellation of elective cases and changes to the provision of emergency surgical care. The aim of this study was to determine whether structural changes made within our facility's surgical department during COVID-19 altered National Emergency Access Target (NEAT) times and impacted on patient outcomes. METHODS: Emergency surgical cases over a 4-month time period were retrospectively collected and statistically analysed, divided into pre- and mid-COVID-19 pandemic. RESULTS: Baseline characteristics between the groups were comparable. There was a significant increase in consultant presence in theatre in the COVID group. There were also statistically significant reductions in NEAT times at each timepoint, although these did not meet national guidelines. There was no change in emergency surgical workload, complication rate or mortality rates within 30 days. CONCLUSION: Any significant change to services requires a coordinated hospital-wide approach, not just from a single department, and clinicians must continue to be wary of benchmarked times as the overall feasibility and safety of NEAT times has also been highlighted again.

Telehealth in surgery: an umbrella review.

BACKGROUND: Telehealth use has increased worldwide during the COVID-19 pandemic. However, hands-on requirements of surgical care may have resulted in slower implementation. This umbrella review (review of systematic reviews) evaluated the perceptions, safety and implementation of telehealth services in surgery, and telehealth usage in Australia between 2020 and 2021. METHODS: PubMed was searched from 2015 to 2021 for systematic reviews evaluating real-time telehealth modalities in surgery. Outcomes of interest were patient and provider satisfaction, safety, and barriers and facilitators associated with its use. Study quality was appraised using the AMSTAR 2 tool. A working group of surgeons provided insights into the clinical relevance to telehealth in surgical practice of the evidence collated. RESULTS: From 2025 identified studies, 17 were included, which were of low to moderate risk of bias. Patient and provider satisfaction with telehealth was high. Time savings, decreased healthcare resource use and lower costs were reported as key advantages of the service. Inability to perform comprehensive examinations was noted as the primary barrier. In Australia, peak telehealth usage coincided with the introduction of temporary telehealth services and increased lockdown measures. CONCLUSIONS: Patients and providers are broadly satisfied with telehealth and its benefits. Barriers may be overcome via multidisciplinary collaboration. Telehealth may benefit surgical care long-term if implemented correctly both during and after the COVID-19 pandemic.

Three-year delayed presentation of femoral pseudoaneurysm after penetrating limb trauma.

BACKGROUND: Delayed presentations of lower limb pseudoaneurysms secondary to penetrating trauma are particularly rare. METHODS: After presentation of this rare case report, we review relevant published literature. RESULTS: We report a rare case of a 55-year-old man with a progressively enlarging mass measuring 15 cm by 15 cm on his right anteromedial thigh 3 years after penetrating trauma. Computer tomography angiogram revealed this to be a large pseudoaneurysm supplied by a side branch artery from the right superficial femoral artery. Using an open approach, the pseudoanerysm was successfully repaired with the side branch oversewn, and the patient made a good recovery being discharged from hospital 4 days later. CONCLUSIONS: Surgeons must retain pseudoaneurysm as a prominent differential for a patient presenting with a progressively enlarging, expansile mass of an extremity after penetrating trauma to ensure urgent investigation and prompt vascular intervention. Both open surgical ablation and endovascular embolization of pseudoaneurysms of the extremities are effective techniques with low rates of complications and morbidity reported in published literature.