scholarly journals Safe Surgery During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Rishi Singhal ◽  
Luke Dickerson ◽  
Nasser Sakran ◽  
Sjaak Pouwels ◽  
Sonja Chiappetta ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Risk Mitigation ◽  
Surgical Techniques ◽  
Research Priorities ◽  
Mitigation Strategies ◽  
Screening Methods ◽  
Safe Surgery ◽  
Increased Risk ◽  
Surgical Teams ◽  
The Impact

Abstract Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

scholarly journals 1628 Vaccination for Safe Surgery During The SARS-Cov-2 Pandemic: Modelling Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Keyword(s):  
General Population ◽  
Elective Surgery ◽  
Risk Difference ◽  
Cancer Surgery ◽  
Number Needed To Treat ◽  
Worst Case ◽  
Registration Data ◽  
Increased Risk ◽  
One Year ◽  
The Impact

Abstract Introduction Compared to the general population, in the postoperative period, surgical patients are both at increased risk of SARS-CoV-2 infection and increased mortality in the event of SARS-CoV-2 infection. This study modelled the impact of preoperative vaccination of patients aged ≥70 years having elective inpatient surgery. Method The primary outcome was the number needed to treat (NNT) to prevent one death over one year following SARS-CoV-2 vaccination. Postoperative SARS-CoV-2 incidence and adjusted mortality risk difference for SARS-CoV-2 infection were estimated from the prospective GlobalSurg-CovidSurg Week study (90,146 elective surgery patients across 1,595 hospitals in 115 countries), were used to estimate lives saved by vaccination in the first 30 postoperative days. SARS-CoV-2 case and death registration data from the Office for National Statistics was used to estimate NNTs for the general population. Best and worst-case scenarios were used to describe uncertainty around estimates. Results Among patients aged ≥70 years undergoing any type of surgery, NNT was estimated to be 332 (best case: 213; worst case: 690). NNT was lower in the cancer surgery subgroup (245 [150-545]). This was more favourable than the NNT for vaccination of the general population aged ≥70 (588 [403-1032]). Globally, vaccinating elective surgery patients aged ≥70 years preoperatively was projected to save 27,356 lives in one year compared to vaccinating the same patients after surgery. Conclusions Preoperative pathways should be set up for the vaccination of patients aged ≥70. In settings with limited vaccine availability, elective cancer surgery patients should be prioritised for vaccination.

scholarly journals Restarting elective endoscopy safely amidst an evolving pandemic and the impact of patient perception

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Nguyen ◽  
Kevin T. Kline ◽  
Shehzad Merwat ◽  
Sheharyar Merwat ◽  
Gurinder Luthra ◽  
...  
Keyword(s):  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Transmission Risk ◽  
Dynamic Monitoring ◽  
Successful Model ◽  
Outpatient Procedures ◽  
Risk Patients ◽  
Risk Mitigation Strategies ◽  
Spread Of Infection ◽  
The Impact

Abstract Background The COVID-19 pandemic has led to disruptions in elective and outpatient procedures. Guidance from the Centers for Medicare and Medicaid Services provided a framework for gradual reopening of outpatient clinical operations. As the infrastructure to restart endoscopy has been more clearly described, patient concerns regarding viral transmission during the procedure have been identified. Moreover, the efficacy of the measures in preventing transmission have not been clearly delineated. Methods We identified patients with pandemic-related procedure cancellations from 3/16/2020 to 4/20/2020. Patients were stratified into tier groups (1–4) by urgency. Procedures were performed using our hospital risk mitigation strategies to minimize transmission risk. Patients who subsequently developed symptoms or tested for COVID-19 were recorded. Results Among patients requiring emergent procedures, 57.14% could be scheduled at their originally intended interval. COVID-19 concerns represented the most common rescheduling barrier. No patients who underwent post-procedure testing were positive for COVID-19. No cases of endoscopy staff transmission were identified. Conclusions Non-COVID-19 related patient care during the pandemic is a challenging process that evolved with the spread of infection, requiring dynamic monitoring and protocol optimization. We describe our successful model for reopening endoscopy suites using a tier-based system for safe reintroduction of elective procedures while minimizing transmission to patients and staff. Important barriers included financial and transmission concerns that need to be addressed to enable the return to pre-pandemic utilization of elective endoscopic procedures.

scholarly journals Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

2021 ◽  
Vol 6 (12) ◽  
pp. e006788
Author(s):  
Edwin Charles Ernest ◽  
Augustino Hellar ◽  
John Varallo ◽  
Leopold Tibyehabwa ◽  
Margaret Mary Bertram ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Safety ◽  
Safe Surgery ◽  
Low Middle Income Countries ◽  
Utilisation Rate ◽  
Surgical Teams ◽  
The Impact

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

scholarly journals FOREIGN INFRASTRUCTURE INVESTMENT IN DEVELOPING COUNTRIES: A DYNAMIC PANEL DATA MODEL OF POLITICAL RISK IMPACTS

2019 ◽  
Vol 25 (2) ◽  
pp. 134-167 ◽  
Author(s):  
Weiling Jiang ◽  
Igor Martek ◽  
M. Reza Hosseini ◽  
Jolanta Tamošaitienė ◽  
Chuan Chen
Keyword(s):  
Developing Countries ◽  
Foreign Direct Investment ◽  
Direct Investment ◽  
Capital Investment ◽  
Risk Mitigation ◽  
Political Risk ◽  
Dynamic Panel Data ◽  
Mitigation Strategies ◽  
Risk Indicators ◽  
The Impact

Foreign direct investment (FDI) is inhibited by political risk. Developing countries tend to experience higher levels of such risk, yet need foreign capital to generate growth. Moreover, foreign direct investment in infrastructure (FDII) – fundamental to economic growth – is particularly sensitive to political risk; characterized by high capital investment, longer investment periods, while especially exposed to mercurial shifts in government policy. Yet, no comprehensive study has been undertaken that measures the impact of political risk on FDII in developing countries. This paper addresses this lack. Twelve political risk indicators, drawn from the International Country Risk Guide Index, are used to quantify the political risk inherent to 90 developing countries, over the period 2006 to 2015. An Arellano-Bond GMM estimator is developed which measures the dollar value impact of risk on both FDI and FDII. A comparison of results confirms that FDII is generally more sensitive to risk than is FDI, however the influence of risk categories is found to vary significantly. The findings can be expected to inform infrastructure policy-makers and foreign investors alike on the dollar-impact of determinable risk levels on foreign-funded projects, and in so doing better facilitate corrective risk mitigation strategies.

scholarly journals Biofuel supply chain risk mitigation strategy framework: Expert interview based Approach

2020 ◽  
Vol 13 (1) ◽  
pp. 179
Author(s):  
Tedy Wachyudi ◽  
Arief Daryanto ◽  
Machfud Machfud ◽  
Yandra Arkeman
Keyword(s):  
Supply Chain ◽  
Risk Mitigation ◽  
Business Practice ◽  
Mitigation Strategies ◽  
Security Framework ◽  
Supply Chain Risk ◽  
Expert Interview ◽  
Risk Mitigation Strategies ◽  
The Impact

Purpose: The purpose of this case study is to develop and framework supply chain characteristics and risk mitigation strategies in the context of biodiesel downstream supply chain.Design/methodology/approach: This study employs an expert interview-based approach as a qualitative approach with a multi-perspectives view.Findings: There are vary strategies among perspectives, such as perspectives of organization and business types, stakeholder types, times and methods. These also shows that business strategy of collaborative, coordinative, and cooperative arise as alternative strategies for each perspective and each level of stakeholder. Those business strategies may apply in a vary operation strategies which linking through an energy security framework element as company’s competitive priorities.Research limitations/implications: The research scope includes only a certain area of the country’s territory and the target company’s supply chain areas of activity. The research method includes only internal stakeholders and experts as respondents and data sources. The level of analysis was only at corporate level in the corporate case study context. The research also targets only a downstream activities of biodiesel supply chain context. The interview-based approach as a qualitative approach faces some subjectivity challenges among respondents.Practical implications: The research result provides some positive implications for business practice, includes how to minimize the impact of supply chain risk on company’s business activities and performance, how supply chain experts and practitioners used risk mitigation practices, how to formulate strategic plans to minimize the impact of supply chain risk and enhance the effectivity and sustainability of the supply chain activities.Social implications: The implication for business practice was that company’s leaders implemented supply chain risk mitigation strategies that provide positive impacts on the more valuable relationship among supply chain actors and stakeholders.Originality/value: The first, is an activities areas and operation schemes-based of biodiesel supply chain point of view. The second, is a multi-perspectives-based biodiesel supply chain characteristics framework. The third, is an energy security framework-based biodiesel risk mitigation strategies framework.

scholarly journals A Preoperative Estimate of Central Venous Pressure Is Associated with Early Fontan Failure

2020 ◽  
Author(s):  
Michael A. Quail ◽  
Ignatius Chan ◽  
Shiv Sarna ◽  
Marina Hughes ◽  
Vivek Muthurangu
Keyword(s):  
Central Venous Pressure ◽  
Risk Mitigation ◽  
Venous Pressure ◽  
Mitigation Strategies ◽  
Receiver Operating Curve ◽  
Electronic Patient Records ◽  
Central Venous ◽  
Increased Risk ◽  
Patients At Risk ◽  
Fontan Failure

AbstractObjectiveEarly Fontan Failure (EFF) is a serious complication following total cavopulmonary connection (TCPC), characterised by high central venous pressure (CVP), low cardiac output and resistance to medical therapy. This study aimed to estimate post-operative CVP in TCPC patients (CVPTCPC) using data routinely collected during pre-operative assessment. We sought to determine if this metric correlated with measured post-operative CVP and if it was associated with EFF.MethodsIn this retrospective study, CVPTCPC was estimated in 131 patients undergoing pre-TCPC assessment by cardiac magnetic resonance imaging and CVP measurement under general anaesthesia. Post-operative CVP during the first 24hours in ICU was collected from electronic patient records in a subset of patients. EFF was defined as death, transplantation, TCPC takedown or emergency fenestration within the first 30days.ResultsEstimated CVPTCPC correlated significantly with CVPICU (r=0.26, p=0.03), particularly in patients without a fenestration (r=0.45, p=0.01). CVPTCPC was significantly associated with EFF (Odds Ratio [OR] 1.12 (1.02-1.24), p=0.02). A threshold of CVPTCPC ≥33mmHg was found to have the highest specificity (90%) and sensitivity (67%) for identifying EFF (area under receiver operating curve, AUC = 0.79), OR 18.8 (3.1-114), p=0.001. This association was stronger in patients with single SVCs.ConclusionsEstimated CVPTCPC is an easily calculated metric combining pre-operative pressure and flow data. Higher CVPTCPC is associated with an increased risk of EFF and is correlated with directly measured post-TCPC pressure. Identification of patients at risk of EFF has the potential to guide risk mitigation strategies.

scholarly journals Dentistry & COVID-19: Spreading facts not myths

2021 ◽  
Vol 7 (4) ◽  
pp. 253-256
Author(s):  
Surbhi Priyadarshi ◽  
Arif Siddique
Keyword(s):  
Dental Treatment ◽  
Clinical Skills ◽  
Risk Mitigation ◽  
Online Communication ◽  
High Volume ◽  
Mitigation Strategies ◽  
Current Crisis ◽  
Dental Services ◽  
Strict Adherence ◽  
The Impact

Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. Among several potential transmission sources in the spreading of the COVID-19, dental services have received a high volume of attention. The aim of this article was to review the available literature on the relevant aspects of dentistry in relation to COVID-19 and to discuss potential impacts of COVID-19 outbreak on clinical dentistry, dental education and research. Although the coronavirus pandemic has caused many difficulties for provision of clinical dentistry, there would be an opportunity for the dental educators to modernize their teaching approaches using novel digital concepts in teaching of clinical skills and by enhancement of online communication and learning platforms. This pandemic has also highlighted some of the major gaps in dental research and the need for new relevant knowledge to manage the current crisis and minimize the impact of such outbreaks on dentistry in the future.

scholarly journals Urology Amidst the War on COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 113-119
Author(s):  
Bishoy Hanna ◽  
Stuart Jackson ◽  
Harry Narroway ◽  
Amanda Chung
Keyword(s):  
Health Care ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Infection Rates ◽  
Testing Procedures ◽  
Care Workers ◽  
Increased Risk ◽  
Hospital Resources ◽  
The Uk ◽  
The Impact

Objectives: We sought to review the impact of the COVID-19 pandemic on the practice of urology internationally, with particular focus on the Australian response. Methods: A literature search of PubMed was conducted using search terms “urology,” “coronavirus,” “COVID-19,”and “surgery.” This generated 165 articles. The abstracts were reviewed for relevance, and 33 articles were selected, reviewed in depth, and information synthesised along with relevant government, surgical college, and urological society policy documents. Results: Extensive health care changes have been implemented worldwide to curb infection rates. Elective surgery cancellations have been widely mandated to curb infection rates with mixed success. Whilst demand on hospital resources was reduced by up to 80%, the estimated cost to clear the surgical backlog in the UK has reached £100 million. Strict perioperative precautions have also been employed with mandatory personal protective equipment for all surgical staff and guidelines fast tracked for safe aerosol-generating procedures. Attempts to reduce exposure to patients and health care workers resulted in compromised operative time, blood loss, and length of hospital stay, with potential increased risk of short- and long-term complications. Systemic changes to education and training have also been made. Clinically, the cancellation of training examinations and a freeze on rotations and elective surgery restrictions have blunted surgical experience and teaching. The effect has rippled through junior doctor positions, with uncertainty remaining for training positions in 2021. Conclusions: The COVID-19 pandemic is the greatest current challenge facing health care worldwide. Amidst elective surgery restrictions, novel preoperative testing procedures and intraoperative precautions, providing safe and appropriate urological care is a major challenge. This review was derived entirely from expert opinion articles. Further research into the virus is needed to bring the world safely through the pandemic, and post-pandemic recovery will likely be the next challenge.

scholarly journals Modelling the impact of reducing control measures on the COVID-19 pandemic in a low transmission setting

2020 ◽  
Author(s):  
Nick Scott ◽  
Anna Palmer ◽  
Dominic Delport ◽  
Romesh Abeysuriya ◽  
Robyn Stuart ◽  
...  
Keyword(s):  
Public Transport ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Control Measures ◽  
Contact Tracing ◽  
Policy Changes ◽  
Low Transmission ◽  
Transmission Setting ◽  
Community Transmission ◽  
The Impact

AbstractAimsWe assessed COVID-19 epidemic risks associated with relaxing a set of physical distancing restrictions in the state of Victoria, Australia – a setting with low community transmission – in line with a national framework that aims to balance sequential policy relaxations with longer-term public health and economic need.MethodsAn agent-based model, Covasim, was calibrated to the local COVID-19 epidemiological and policy environment. Contact networks were modelled to capture transmission risks in households, schools and workplaces, and a variety of community spaces (e.g. public transport, parks, bars, cafes/restaurants) and activities (e.g. community or professional sports, large events). Policy changes that could prevent or reduce transmission in specific locations (e.g. opening/closing businesses) were modelled in the context of interventions that included testing, contact tracing (including via a smartphone app), and quarantine.ResultsPolicy changes leading to the gathering of large, unstructured groups with unknown individuals (e.g. bars opening, increased public transport use) posed the greatest risk, while policy changes leading to smaller, structured gatherings with known individuals (e.g. small social gatherings) posed least risk. In the model, epidemic impact following some policy changes took more than two months to occur. Model outcomes support continuation of working from home policies to reduce public transport use, and risk mitigation strategies in the context of social venues opening, such as >30% population-uptake of a contact-tracing app, physical distancing policies within venues reducing transmissibility by >40%, or patron identification records being kept to enable >60% contact tracing.ConclusionsIn a low transmission setting, care should be taken to avoid lifting sequential COVID-19 policy restrictions within short time periods, as it could take more than two months to detect the consequences of any changes. These findings have implications for other settings with low community transmission where governments are beginning to lift restrictions.

scholarly journals TP10.2.7Reintroduction of elective colorectal cancer surgery following the first wave of Covid-19 in the UK – an audit of risk mitigation strategies and review of patient outcome

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Francesca Malcolm ◽  
James Chean Khun Ng ◽  
William Speake
Keyword(s):  
Colorectal Cancer ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Colorectal Cancer Surgery ◽  
Mortality And Morbidity ◽  
Defunctioning Ileostomy ◽  
Operative Strategies ◽  
Risk Mitigation Strategies ◽  
The Uk ◽  
The Impact

Abstract Aim Perioperative acquisition of Covid-19 is associated with high mortality and morbidity. We have analysed the effectiveness of newly designed ‘green’ pathway for elective colorectal cancer (CRC) patients, which aimed to minimise risk of Covid-19. Method Data collected with concurrent implementation of ‘green’ pathway for all patients undergoing CRC surgery over a 6 week period following the ‘first wave’ of the Covid-19 pandemic. The standard audited were appropriately timed pre-operative CT chest, Covid-19 swabs and shielding adherence. The impact of positive pre-operative swabs and post-operative complications were analysed. Additional risk mitigation strategies included dual consultant operating, open operating, and defunctioning ileostomy for high risk anastomoses. Results 49 operations performed of 56 planned. 1 cancelled due to patient being positive for Covid-19, 5 due to progression of cancer on restaging CT, 1 required further medical optimisation. All had a 2 week pre-operative swab and then shielded until the day of the operation. 48/49 had swab 2 days pre-op. CT chest performed in all, 37 (66.7%) were to restage. 4 (8%) had post-operative complication graded as ≥ 2 on Clavien-Dindo score; none of which were Covid related. 1 patient tested positive for Covid-19 post-operatively but remained asymptomatic. All procedures were open and performed by 2 consultants. Conclusion We demonstrate an effective pathway and various operative strategies which can be employed to reduce risk for patients undergoing CRC surgery in the midst of the ongoing global pandemic.

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