Impact of the COVID-19 pandemic on the management and outcomes of emergency surgical patients: A retrospective cohort study.

INTRODUCTION: The COVID-19 pandemic has led to drastic measures being implemented for the management of surgical patients across all health services worldwide, including the National Health Service in the United Kingdom. It is suspected that the virus has had a detrimental effect on perioperative morbidity and mortality. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on these outcomes in emergency general surgical patients. METHODS: Emergency general surgical admissions were included in this retrospective cohort study in one of the COVID-19 hotspots in the South East of England. The primary outcome was the 30-day mortality rate. Secondary outcomes included the length of stay in hospital, complication rate and severity grade and admission rates to the ITU. RESULTS: Of 123 patients, COVID-19 was detected in 12.2%. Testing was not carried out in 26%. When comparing COVID-positive to COVID-negative patients, the mean age was 71.8 + 8.8 vs. 50.7 + 5.7, respectively, and female patients accounted for 40.0 vs. 52.6%. The 30-day mortality rate was 26.7 vs. 3.9 (OR 6.49, p = 0.02), respectively. The length of stay in hospital was 20.5 + 22.2 vs. 7.7 + 9.8 (p < 0.01), the rate of complications was 80.0 vs. 23.7 (OR 12.9, p < 0.01), and the rate of admission to the ITU was 33.3 vs. 7.9% (OR 5.83, p = 0.01). CONCLUSION: This study demonstrates the detrimental effect of COVID-19 on emergency general surgery, with significantly worsened surgical outcomes.

The important role of in-situ simulation in preparing surgeons for the COVID-19 pandemic.

BACKGROUND: Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. METHODS: This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. RESULTS: 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. CONCLUSION: In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

Quality of Life Using the Carolinas Comfort Scale for Laparoscopic Incisional Hernia Repair: A 12-Year Experience in a Retrospective Observational Study.

Background: Incisional hernias are a common complication of abdominal surgery (10%-35%) and are notorious for recurrence. Laparoscopic incisional hernia repair (LIHR) was first performed in 1991 and is reported to have lower recurrence rates. Few studies to date have assessed quality of life (QoL) resulting from a repair. The purpose of this observational study was to present a 12-year experience performing LIHR, with a focus on the impact on QoL. Methods: All adult patients undergoing elective LIHR performed by a single surgeon, whether primary or recurrent, were included in the study. The data collection was performed prospectively between 2007 and 2019 to include demographic details, intraoperative findings and postoperative short- and longterm outcomes. We used the Carolinas Comfort Scale (CCS) to assess QoL following surgery. Results: Ninety-seven patients were included in the study. Patients had a median age of 57 years, body mass index of 32 kg/m2, 35% were male and 88% were American Society of Anesthesiologists (ASA) class I or II. The duration of surgery was 90 minutes*. Nineteen percent of patients had complications during or after surgery; 1 (1%) had recurrence. length of stay in hospital was 1* (0-12) days and long-term follow-up period was 42* (2-140) months after surgery. Time of return to daily activities was 14* (1-365) days. Eighty-six percent of patients rated their experience undergoing LIHR as "Excellent" or "Good". Regarding QoL after surgery, scores on the CCS indicated that 82% of patients had minimal or no discomfort following surgery, and only 1% had significant discomfort. *Presented as median. Conclusions: The technique for LIHR displayed in this study is safe and effective. There was an acceptable rate of complications, with a low recurrence rate. Patients were highly satisfied and had a good QoL after the procedure. Research Registry ID Number: researchregistry6056.