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1.
BMC Surg ; 21(1): 177, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794852

RESUMEN

BACKGROUND: Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. METHODS: This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. RESULTS: Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). CONCLUSIONS: PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.


Asunto(s)
Dimensión del Dolor , Dolor Postoperatorio , Náusea y Vómito Posoperatorios , Procedimientos Quirúrgicos Electivos/efectos adversos , Hospitales Públicos , Hospitales Universitarios , Humanos , Medio Oriente/epidemiología , Dolor Postoperatorio/epidemiología , Náusea y Vómito Posoperatorios/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
2.
Georgian Med News ; (311): 17-21, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33814383

RESUMEN

The objective and the goal of this study was to determine how ERAS guidelines affected on hospital stay days and other complications rates in case of elective colorectal surgery in our clinic, compared to traditional care methods. First of all, all team members including surgeons, anesthetists, nurses were being trained in ERAS guidelines principals during two months and we started active implementation process after this. 87 patients, who were needed to be done colorectal surgery treatment, were actively treated according to ERAS guidelines and these patients were gathered in experimental group. At the same time, we started to collect data retrospectively from last 2 years elective colorectal surgery cases and sorted them according to preoperative, intraoperative surgical and anesthesia data, postoperative analgesia, all type of complications. 120 patients were placed in traditional care group (control group). In traditional care group open colorectal surgery was associated with long length of stay 8-10 days. High rates of surgical site infection-24.2%, readmission rate during 30 days-30.8%, PONV-44.2%, respiratory complication-6.7%, deep vein thrombosis-3.3%, urinary retention-2.5%, prolonged postoperative ileus 16.7%. We included 87 patients in ERAS care group during 2 years. In this group our study showed big reduction of hospital stay days and it was average 5 days. Compared to traditional care group incidence of respiratory complications was 0, postoperative PONV- 6.9%, postoperative ileus-5.7%, deep vein thrombosis-0, urinary retention-0, readmission rate-0, surgical site infection-3.4%.


Asunto(s)
Cirugía Colorrectal , Procedimientos Quirúrgicos del Sistema Digestivo , Recuperación Mejorada Después de la Cirugía , Cirugía Colorrectal/efectos adversos , Procedimientos Quirúrgicos Electivos , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos
3.
BMC Surg ; 21(1): 151, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-33743649

RESUMEN

BACKGROUND: Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). METHODS: We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. RESULTS: In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence. CONCLUSIONS: Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.


Asunto(s)
Colecistectomía Laparoscópica , Conversión a Cirugía Abierta , Procedimientos Quirúrgicos Electivos , Adulto , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica/estadística & datos numéricos , Conversión a Cirugía Abierta/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Cirujanos/estadística & datos numéricos , Adulto Joven
4.
Indian J Ophthalmol ; 69(4): 964-970, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33727467

RESUMEN

Purpose: The aim of this study was to report the use and the impact of a point-of-care rapid antigen test (PoC-RAT) at a tertiary eye care facility in facilitating commencement of elective surgeries, contact tracing of exposed health care professionals (HCPs) and ancillary hospital staff, and implementation of back-to-work (BTW) policy for them. Methods: Retrospective analysis of subjects undergoing PoC-RAT for COVID-19 infection at a tertiary level dedicated eye care facility. Decision making with regard to commencement of elective surgeries post COVID-19 related discontinuation of services, contact tracing of HCPs and ancillary hospital staff exposed to known COVID-19 cases and implementation of back-to-work policy for all staff based upon the results of PoC-RAT were studied. Results: A total of 311 subjects (224 patients and 87 hospital staff) were tested. Overall positivity rate was around 7%. Asymptomatic patients who were screened preoperatively had a lower positivity rate at around 3% compared to the staff (who were either known contacts or were symptomatic) at around 17%. Contact tracing found three-quarters of the staff at low risk and only one quarter at medium or high risk. Among patients, 97% of those followed up for at least 2 weeks after the test remained healthy. For staff, this was around 65%. Conclusion: Based on our preliminary results, we suggest that PoC-RAT may be considered routinely for indication-based preoperative screening of asymptomatic patients, and for on-campus screening, contact tracing and implementation of BTW policies for HCPs and ancillary hospital staff at a tertiary level eye care facility.


Asunto(s)
Antígenos Virales/inmunología , /diagnóstico , Trazado de Contacto , Procedimientos Quirúrgicos Electivos , Reinserción al Trabajo , /inmunología , Adulto , Toma de Decisiones , Femenino , Política de Salud , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Cuidados Preoperatorios , Estudios Retrospectivos , Centros de Atención Terciaria
7.
BMC Surg ; 21(1): 173, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33784994

RESUMEN

BACKGROUND: Gastrointestinal surgery in elderly individuals presents unexpected postoperative complications. However, predicting postoperative complications in elderly patients undergoing gastrointestinal surgeries is challenging because of the lack of a reliable preoperative evaluation system. We aimed to prospectively evaluate three new preoperative assessment methods to predict the postoperative complications in elderly patients undergoing elective gastrointestinal surgery. Moreover, we aimed to identify new risk factors of postoperative complications in this patient group. METHODS: This prospective cohort study enrolled 189 patients (age ≥ 65 years) who underwent elective gastrointestinal surgery at Tokyo Medical University Hachioji Medical Center between April 2017 and March 2019. Assessments performed preoperatively included the biological impedance analysis for evaluating the skeletal muscle mass, the SF-8 questionnaire for evaluating the subjective health-related quality of life, and the blood pressure/pulse wave test for assessing arteriosclerosis. The risk factors for Clavien-Dindo Grade ≥ III postoperative complications were assessed using these new evaluation methods. RESULTS: Clavien-Dindo Grade ≥ III postoperative complications were observed in 28 patients (14.8%). Univariate and multivariate analyses identified male sex, low skeletal muscle mass, and cardio-ankle vascular index ≥ 10 (arteriosclerosis) as significant independent risk factors of developing Grade ≥ III complications. CONCLUSIONS: Male sex, low skeletal muscle mass, and arteriosclerosis were significant risk factors of postoperative complications in elderly patients undergoing elective gastrointestinal surgery. The obtained knowledge could be useful in identifying high-risk patients who require careful perioperative management.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Procedimientos Quirúrgicos Electivos , Complicaciones Posoperatorias , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos Electivos/efectos adversos , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Factores de Riesgo
9.
BMJ ; 372: n375, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33687926

RESUMEN

OBJECTIVE: To assess whether a clinically relevant difference exists in patients' perceptions of symptoms, knee function, and ability to participate in sports over a period of two years after rupture of the anterior cruciate ligament (ACL) between two commonly used treatment regimens. DESIGN: Open labelled, multicentre, parallel randomised controlled trial (COMPARE). SETTING: Six hospitals in the Netherlands, between May 2011 and April 2016. PARTICIPANTS: Patients aged 18 to 65 with an acute rupture of the ACL, recruited from six hospitals. Patients were evaluated at three, six, nine, 12, and 24 months. INTERVENTIONS: 85 patients were randomised to early ACL reconstruction and 82 to rehabilitation followed by optional delayed ACL reconstruction after a three month period (primary non-operative treatment). MAIN OUTCOMES: Patients' perceptions of symptoms, knee function, and ability to participate in sporting activities were assessed with the International Knee Documentation Committee score (optimum score 100) at each time point over 24 months. RESULTS: Between May 2011 and April 2016, 167 patients were enrolled in the study and randomised to one of two treatments (mean age 31.3; 67 (40.%) women), and 163 (98%) completed the trial. In the rehabilitation and optional delayed ACL reconstruction group, 41 (50%) patients underwent reconstruction during follow-up. After 24 months, the early ACL reconstruction group had a significantly better (P=0.026) but not clinically relevant International Knee Documentation Committee score (84.7 v 79.4 (difference between groups 5.3, 95% confidence interval 0.6 to 9.9). After three months of follow-up, the International Knee Documentation Committee score was significantly better (P=0.002) for the rehabilitation and optional delayed ACL reconstruction group (difference between groups -9.3, -14.6 to -4.0). After nine months of follow-up, the difference in the International Knee Documentation Committee score changed in favour of the early ACL reconstruction group. After 12 months, differences between the groups were smaller. In the early ACL reconstruction group, four re-ruptures and three ruptures of the contralateral ACL occurred during follow-up versus two re-ruptures and one rupture of the contralateral ACL in the rehabilitation and optional delayed ACL reconstruction group. CONCLUSIONS: In patients with acute rupture of the ACL, those who underwent early surgical reconstruction, compared with rehabilitation followed by elective surgical reconstruction, had improved perceptions of symptoms, knee function, and ability to participate in sports at the two year follow-up. This finding was significant (P=0.026) but the clinical importance is unclear. Interpretation of the results of the study should consider that 50% of the patients randomised to the rehabilitation group did not need surgical reconstruction. TRIAL REGISTRATION: Netherlands Trial Register NL 2618.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/rehabilitación , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Tratamiento Conservador/métodos , Procedimientos Quirúrgicos Electivos/métodos , Adolescente , Adulto , Anciano , Lesiones del Ligamento Cruzado Anterior/diagnóstico , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Recuperación de la Función , Volver al Deporte , Tiempo de Tratamiento , Resultado del Tratamiento , Adulto Joven
10.
Clinics (Sao Paulo) ; 76: e2507, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33787677

RESUMEN

OBJECTIVES: Since the outbreak of the novel coronavirus disease 2019 (COVID-19), all health services worldwide underwent profound changes, leading to the suspension of many elective surgeries. This study aimed to evaluate the safety of elective colorectal surgery during the pandemic. METHODS: This was a retrospective, cross-sectional, single-center study. Patients who underwent elective colorectal surgery during the COVID-19 pandemic between March 10 and September 9, 2020, were included. Patient data on sex, age, diagnosis, types of procedures, hospital stay, mortality, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperative screening tests were recorded. RESULTS: A total of 103 colorectal surgical procedures were planned, and 99 were performed. Four surgeries were postponed due to positive preoperative screening for SARS-CoV-2. Surgical procedures were performed for colorectal cancer (n=90) and inflammatory bowel disease (n=9). Laparoscopy was the approach of choice for 43 patients (43.4%), 53 (53.5%) procedures were open, and 3 (3%) procedures were robotic. Five patients developed COVID-19 in the postoperative period, and three of them died in the intensive care unit (n=3/5, 60% mortality). Two other patients died due to surgical complications unrelated to COVID-19 (n=2/94, 2.1% mortality) (p<0.01). Hospital stay was longer in patients with SARS-CoV-2 infection than in those without (38.4 versushttps://doi.org/10.3 days, respectively, p<0.01). Of the 99 patients who received surgical care during the pandemic, 94 were safely discharged (95%). CONCLUSION: Our study demonstrated that elective colorectal surgical procedures may be safely performed during the pandemic; however, preoperative testing should be performed to reduce in-hospital infection rates, since the mortality rate due to SARS-CoV-2 in this setting is particularly high.


Asunto(s)
Neoplasias Colorrectales , Cirugía Colorrectal , Estudios Transversales , Procedimientos Quirúrgicos Electivos/efectos adversos , Humanos , Pandemias , Estudios Retrospectivos
11.
Medicine (Baltimore) ; 100(12): e25235, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761716

RESUMEN

BACKGROUND: This study aimed to evaluate the efficacy of peri-induction forced air warming to prevent inadvertent perioperative hypothermia, defined as a reduction in body temperature to <36.0°C during the perioperative period, in intraoperatively warmed patients receiving major surgery lasting >120 minutes. METHODS: In total, 130 patients scheduled for elective surgery under general anesthesia lasting >120 minutes were divided into 2 groups: peri-induction warming (n = 65) and control (n = 65). Patients in the peri-induction warming group were warmed during the anesthetic induction period using a forced-air warmer set at 47°C, whereas patients in the control group were covered passively with a cotton blanket. All patients were warmed with a forced-air warmer during surgery. Body temperature was measured using a tympanic membrane thermometer in the pre- and postoperative periods and using a nasopharyngeal temperature probe during surgery. Patients were evaluated for shivering scale score, thermal comfort scale score, and satisfaction score in the post-anesthesia care unit. RESULTS: The incidence rates of intraoperative and postoperative hypothermia were lower in the peri-induction warming group than in the control group (19.0% vs 57.1%, P < .001; 3.3% vs 16.9%, P = .013, respectively). Body temperature was higher in the peri-induction warming group (P < .001). However, intraoperative blood loss, as well as postoperative thermal comfort scale score, shivering scale score, and patient satisfaction score, were similar between groups. Post-anesthesia care unit duration was also similar between groups. CONCLUSIONS: Peri-induction active forced air warming is an effective, simple, and convenient method to prevent inadvertent perioperative hypothermia in intraoperatively warmed patients undergoing major surgery lasting >120 minutes.


Asunto(s)
Anestesia General , Procedimientos Quirúrgicos Electivos/efectos adversos , Calefacción/métodos , Hipotermia , Complicaciones Posoperatorias , Termometría/métodos , Anestesia General/efectos adversos , Anestesia General/métodos , Temperatura Corporal , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Hipotermia/etiología , Hipotermia/prevención & control , Masculino , Persona de Mediana Edad , Atención Perioperativa/métodos , Periodo Perioperatorio/efectos adversos , Periodo Perioperatorio/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento
14.
BJS Open ; 5(2)2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33688956

RESUMEN

BACKGROUND: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. METHODS: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). RESULTS: Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7-12, this decreased to 9.2-13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. CONCLUSION: This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.


Asunto(s)
Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Absentismo Familiar/estadística & datos numéricos , Fuerza Laboral en Salud , Cuarentena/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Cirujanos/provisión & distribución , Servicio de Cirugía en Hospital , Estudios Transversales , Humanos , Internacionalidad
15.
Neurol India ; 69(1): 21-25, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33642265

RESUMEN

Background: As the world faces a new viral pandemic, which has spread very rapidly, initial response from most countries was to suspend nonemergent health services so that available resources can be diverted to handle the large numbers of patients with COVID-19 infection. Many societies issued guidelines to suspend or postpone nonemergent surgeries. Methods: We reviewed the emerging evidence regarding the impact of COVID-19 infection in neurosurgery and the postponement of elective surgeries. Results and Observations: COVID-19 infection poses serious threat in hospitals in the form of cross-infection, hospital staff falling sick, with potential risk to overwhelm or paralyze the healthcare. In addition, we have come to realize the significant perioperative morbidity and mortality secondary to active COVID-19 infection. All these strongly favor suspension of elective neurosurgical services. However, these have to be weighed against the fallout due to prolonged postponement of neurosurgical treatment for conditions, which can progress and cause neurological deterioration. Conclusion: This article discusses the contemporary published literature regarding the perioperative risk of COVID-19 infection, impact of postponed surgeries, challenges, risk assessment and guidelines for elective neurosurgery at this point of time.


Asunto(s)
Procedimientos Quirúrgicos Electivos , Neurocirugia , Procedimientos Neuroquirúrgicos , Humanos
16.
BMC Surg ; 21(1): 132, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726715

RESUMEN

BACKGROUND: To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards. METHODS: Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days). RESULTS: Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS. CONCLUSIONS: Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team's expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.


Asunto(s)
Colectomía , Relaciones Interprofesionales , Grupo de Atención al Paciente , Rol Profesional , Estudios de Cohortes , Procedimientos Quirúrgicos Electivos , Recuperación Mejorada Después de la Cirugía , Adhesión a Directriz/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Nueva Zelanda , Grupo de Atención al Paciente/organización & administración , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento
18.
World Neurosurg ; 148: 251-255, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33770847

RESUMEN

The COVID-19 pandemic has impacted neurosurgery in unforeseeable ways. Neurosurgical patient care, research, and education have undergone extraordinary modifications as medicine and mankind have adapted to overcome the challenges posed by this pandemic. Some changes will disappear as the situation slowly recovers to a prepandemic status quo. Others will remain: This pandemic has sparked some long-overdue systemic transformations across all levels of medicine, including in neurosurgery, that will be beneficial in the future. In this paper, we present some of the challenges faced across different levels of neurosurgical clinical care, research, and education, the changes that followed, and how some of these modifications have transformed into opportunities for improvement and growth in the future.


Asunto(s)
Investigación Biomédica/métodos , Prestación de Atención de Salud/métodos , Neurocirugia/métodos , Cuidados Críticos , Educación a Distancia/métodos , Procedimientos Quirúrgicos Electivos , Capacidad de Camas en Hospitales , Humanos , Unidades de Cuidados Intensivos , Neurocirugia/educación , Procedimientos Neuroquirúrgicos , Quirófanos , Innovación Organizacional , Consulta Remota/métodos , Telemedicina/métodos
19.
Updates Surg ; 73(2): 731-744, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33656697

RESUMEN

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020). RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.


Asunto(s)
/epidemiología , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Control de Infecciones/normas , Laparoscopía/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Humanos , Italia/epidemiología , Pandemias , Encuestas y Cuestionarios
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