[The Impact of Lockdown during the COVID-19 Pandemic on Care for Elective Patients (C-elective Study) - Results of a Multicenter Survey]. / Die Auswirkung des Lockdowns während der COVID-19-Pandemie auf die Versorgung von elektiven Patienten (C-elective-Studie).

BACKGROUND: Due to the COVID-19-related lockdown regulations, surgical clinics had to cut down elective procedures. The impact of the cancellation and postponing surgery on patients is unclear. METHODS: All patients from six hospitals with canceled surgery during the first lockdown (03/16-04/24/2020) were asked to answer a questionnaire. RESULTS: In total, 225 patients took part. In 88 (39.1%) patients, the disease-related complaints changed, mainly towards an increase in severity (82.6%). That was especially true for hernia patients (44.4%). In 4% of the cases, there was a complication requiring surgery in the time interval between the original date of the operation and the interview. For about a third, the cancelation of scheduled surgery caused major administrative difficulties. Most of the patients (76.3%) understood the measures taken, though 40.4% of them considered that their indication was very urgent. DISCUSSION AND CONCLUSION: The overall complication rate was low, and patients agreed to the measures taken; however, especially hernia patients showed increasing symptoms and some acute incarcerations. It seems reasonable to monitor symptomatic patients closely, in order to prioritise them when surgical capacity is restricted.

Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany.

PURPOSE: The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. METHODS: Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed. RESULTS: A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change. CONCLUSION: The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained.

[Pharmacological prophylaxis of thromboembolism in daily clinical practice: Evaluation of the clinical decision-making process]. / Medikamentöse Thrombembolieprophylaxe im klinischen Alltag-Evaluation der ärztlichen Entscheidungsfindung.

BACKGROUND: Considering the amount of national and international scientific evidence regarding the use of anticoagulants in the periprocedural prevention of thromboembolism, the decision-making process when prescribing anticoagulants is complex. Due to frequent prescriptions for inpatients, the topic is of high significance. This decision-making process in our hospital is the main focus of the study. METHODS: In a standardised survey, a target group of physicians was asked about their decision-making process with regard to the prescription of anticoagulants in the periprocedural period. For this study a questionnaire was developed consisting of 12 survey questions. Data from 130 participants was collected and analysed. RESULTS: Generally, there was a high level of agreement on the importance of venous thromboembolism prophylaxis. Significant differences exist between medical specialities. A gap between scientific evidence and clinical practice among the respondents could be identified. The decision-making process when prescribing anticoagulants was not documented by the physicians. CONCLUSIONS: A combined approach consisting of structured documentation with electronic decision support in combination with standardised treatment methods and educational measures can be a useful solution.

Intraoperative consultation as an instrument of quality management.

BACKGROUND: This study was designed to investigate the effectiveness of intraoperative consultation (IOC) with regard to its feasibility for improving quality management. IOC comprises an assessment of major steps in the operative procedure by another surgeon requested by the operating surgeon to be present in the operating room in a consultative capacity during the operation. METHODS: Between January and June 2008, IOC was implemented in 1217 operations. Data on the frequency of the feasibility of IOC and on whether IOC led to decisions influencing the course of the procedure were measured. RESULTS: A total of 872 IOCs were performed: regular IOC in 708 cases (81%), and tactical IOC in 164 cases (19%). In 70 cases (8%), consultation resulted in minor changes, and in 59 cases (7%) major clinically relevant revision of the operative strategy was deemed necessary. CONCLUSIONS: It was found that IOC can be performed in the majority of cases. In the case of tactical IOC in particular, a large number of treatment-relevant decisions are taken. This means that in the area of operative disciplines, IOC represents a potential preventive strategy within the framework of quality management.