scholarly journals The impact of COVID-19 on emergency surgical presentations in a university teaching hospital

2021 ◽  
Author(s):  
Ahmed M. Kamil ◽  
Matthew G. Davey ◽  
Fadi Marzouk ◽  
Rish Sehgal ◽  
Amy L. Fowler ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Historical Data ◽  
Severe Disease ◽  
University Teaching ◽  
Readmission Rates ◽  
Descriptive Data ◽  
Operative Complications ◽  
Hospital Patients ◽  
The Impact

Abstract Introduction The Coronavirus-19 (COVID-19) pandemic has led to a 50–70% reduction in acute non-COVID-19 presentations to emergency departments globally. Aim To determine the impact of COVID-19 on incidence, severity, and outcomes of acute surgical admissions in an Irish University teaching hospital. Methods Descriptive data concerning patients presenting with acute appendicitis, diverticulitis, and cholecystitis were analysed and compared from March–May 2020 to March–May 2019. Results Acute surgical admissions decreased in March from 191 (2020) to 55 (2019) (55%), before increasing by 28% in April (2019: 119, 2020: 153). Admissions due to acute cholecystitis reduced by 33% (2019: 33, 2020: 22), with increased severity at presentation (P = 0.079) and higher 30-day readmission rates (P = 0.056) reported. Acute appendicitis presentations decreased by 44% (2019: 78, 2020: 43, P = 0.019), with an increase in severity (P < 0.001), conservative management (P < 0.001), and post-operative complications (P = 0.029) in 2020 compared to the same period in 2019. Conclusion COVID-19 has potentiated a significant reduction in acute surgical presentations to our hospital. Patients presenting with acute appendicitis during the pandemic had more severe disease, were more likely to have complications, and were significantly more likely to be managed conservatively when compared to historical data.

scholarly journals SP10.1.3 The presentation, management and outcomes of acute appendicitis: a comparison of patients presenting during the COVID-19 pandemic and those presenting in a pre-COVID-19 period

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Matthew Davenport ◽  
Alex Clarke ◽  
Stella Smith ◽  
Panos Stathakis ◽  
Christian Macutkiewicz ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Wound Infections ◽  
Open Appendicectomy ◽  
Readmission Rates ◽  
Significant Difference ◽  
Operative Complications ◽  
The Impact ◽  
Post Operative Complications

Abstract Aims This study assesses the impact of COVID-19 on the presentation and management of acute appendicitis (AA). Patients presenting with AA during the first wave of the COVID-19 pandemic are compared to a pre-COVID-19 cohort. Methods Patients admitted to a single acute NHS hospital with AA between April and July in 2019 and 2020 were retrospectively identified. Data on presentation, treatment and outcomes was collected. Results 56 patients were identified in 2019, and 37 in 2020. A greater proportion of patients presented later (&gt;3 days of symptoms) in 2020 (2019=15.6%, 2020=32.4%, p &lt; 0.05). There was no significant difference in the proportion of patients presenting systemically unwell (pyrexial & tachycardic) or with high inflammatory markers (CRP &gt; 50 and white cell count &gt; 15). In 2020, more patients were managed conservatively (2019=7.1%, 2020=35.1%, p &lt; 0.05). Among those who were managed operatively, 75% underwent open appendicectomy in 2020, compared to 7.7% (including cases converted to open from laparoscopic) in 2019. Patients managed operatively during the COVID-19 pandemic had significantly more post-operative complications (2019=17.3%, 2020=50%, p &lt; 0.05). Common post-operative complications in 2020 were abdominal collections (16.7%) and wound infections (12.5%). Median duration of admission was similar (2019=3 days, 2020=2 days) and there was no significant difference in 30-day readmissions (2019=8.9%, 2020=13.5%, p = 0.48). Conclusions AA patients in the COVID-19 pandemic were more likely to present later and were more likely to be managed conservatively or with open appendicectomy. There was a higher rate of post-operative complications for patients in 2020. Duration of stay and readmission rates were similar.

scholarly journals 213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S126
Author(s):  
Laura Marks ◽  
Evan Schwarz ◽  
David Liss ◽  
Munigala Satish ◽  
David K Warren ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hospital Readmissions ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Readmission Rates ◽  
Persons Who Inject Drugs ◽  
Increased Risk ◽  
Hospital Patients ◽  
The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of family function impact on depression severity among infertile women attending a teaching hospital in South-South Nigeria

2020 ◽  
Vol 6 (8) ◽  
pp. FSO595
Author(s):  
Alex A Adelosoye ◽  
Olumuyiwa J Fasipe ◽  
Elihu I Medunoye ◽  
Onyekachukwu C Adelosoye ◽  
Elisha O Sunday
Keyword(s):  
Teaching Hospital ◽  
Significant Relationship ◽  
Severe Depression ◽  
Family Dysfunction ◽  
University Teaching ◽  
Depression Severity ◽  
Family Function ◽  
Severity Of Depression ◽  
Husband Support ◽  
The Impact

Aim: Family function and husband support can impact depression severity in women with infertility disorder. The aim of this study was to assess the impact of family function and husband support on depression severity among women with infertility disorder at the fertility clinics of a University Teaching Hospital, South-South, Nigeria. Methodology: A cross-sectional descriptive study was carried out among 341 female respondents attending the University of Benin Teaching Hospital fertility clinics over a 3-month period, using a semistructured interviewer administered questionnaire. Data obtained were analyzed. Result: Respondents mean age was 36 ± 5.3 years. The overall prevalence for depression in this study was 42.5% with a breakdown of 64.2%, 30.4% and 5.4% of these depressed participants having mild, moderate and severe depression, respectively. Family dysfunction had a statistically significant relationship with severity of depression in women with infertility (p < 0.001). A statistically significant relationship was established between poor husband support and the severity of depression (p < 0.001). Conclusion: Depression is highly prevalent among women with infertility disorder, severe depression was associated with family dysfunction. Good family function would reduce the severity of depression.

scholarly journals Diagnostic Accuracy of the Alvarado Scoring System in Patients Undergoing Appendicectomy at the University Teaching Hospital in Lusaka

2020 ◽  
Vol 4 (2) ◽  
pp. 21-28
Author(s):  
Songiso Mutumba ◽  
◽  
J Mulundika ◽  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Teaching Hospital ◽  
Roc Curve ◽  
Scoring System ◽  
Area Under The Curve ◽  
University Teaching ◽  
Alvarado Score ◽  
Negative Case ◽  
The University

Background: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis has been associated with a reduction of negative appendicectomies. This study aimed to assess the diagnostic accuracy of the Alvarado scoring system at predicting acute appendicitis in patients undergoing appendicectomy at the University Teaching Hospital (UTH). Methods: A prospective study was done to evaluate the diagnostic value of the Alvarado score in patients undergoing appendicectomy at the UTH. Data was collected from the participants diagnosed with acute appendicitis and undergoing appendicectomy. The Alvarado scores for all the participants enrolled into the study were tabulated and correlated with the histopathology results. The sensitivity and the specificity of the Alvarado score was determined and used to construct the ROC curve using the SPSS version 20. The area under the curve was used to determine the diagnostic accuracy of the Alvarado score in this study. Setting: The University Teaching Hospital in Lusaka, Zambia. Results: To determine the diagnostic accuracy of the Alvarado score the ROC curve test was run in SPSS version 20. The results showed that the area under the curve was C=0.842 with SE=0.047 and 95% CI from 0.750 to 0.934. The area under the curve represents the probability that the Alvarado score result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. It shows from the ROC that the Alvarado score is a good indicator to anticipate acute appendicitis. In other words, these results have confirmed that the Alvarado scoring system has very high predictive ability to discriminate acute appendicitis from normal appendix subjects. Conclusion: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis at UTH will reduce the rate of negative appendicectomies. This will lead to a reduction in unnecessary operations, which are a burden on the health care system.

scholarly journals Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

2011 ◽  
Vol 93 (8) ◽  
pp. 620-623 ◽  
Author(s):  
SR Markar ◽  
A Karthikesalingam ◽  
J Cunningham ◽  
C Burd ◽  
G Bond-Smith ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Appendicitis ◽  
Medical Records ◽  
Operative Time ◽  
University Teaching ◽  
Complication Rates ◽  
Operative Complications ◽  
Negative Appendicectomy ◽  
Appendiceal Perforation ◽  
Post Operative Complications

INTRODUCTION The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London. METHODS This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications. RESULTS All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009 (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445), perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029) or perforation (p=0.014). CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

scholarly journals The impact of HIV-1 subtypes on virologic and immunologic treatment outcomes at the Lagos University Teaching Hospital: A longitudinal evaluation

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0238027
Author(s):  
Ann Abiola Ogbenna ◽  
Seema Meloni ◽  
Seth Inzaule ◽  
Raph L. Hamers ◽  
Kim Sigaloff ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Teaching Hospital ◽  
University Teaching ◽  
Longitudinal Evaluation ◽  
The Impact ◽  
Hiv 1
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