scholarly journals 579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Chatzikonstantinou ◽  
M David ◽  
A Pouncey ◽  
F Aljarad ◽  
P Sorelli
Keyword(s):  
General Surgery ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Emergency Operation ◽  
Queen Elizabeth Hospital ◽  
Local Data ◽  
Number Of Patients ◽  
Few Data ◽  
Surgery Department ◽  
The Impact

Abstract Background The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery. Aim To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19. Method Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team. Results A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19). Conclusions CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.

scholarly journals 575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Chatzikonstantinou ◽  
A Pouncey ◽  
M l David ◽  
F Aljarad ◽  
P Sorelli
Keyword(s):  
Acute Appendicitis ◽  
General Surgery ◽  
Emergency Services ◽  
Surgical Patients ◽  
Queen Elizabeth Hospital ◽  
Single Centre ◽  
Open Procedure ◽  
Negative Appendicectomy ◽  
Surgery Department ◽  
The Impact

Abstract Introduction The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients. Aim To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG. Method A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019. Results A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019. Conclusions There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.

scholarly journals Effects of COVID-19 pandemic on general surgical emergencies: Are some emergencies really urgent? Level 1 Trauma center experience

2020 ◽  
Author(s):  
Ahmet Surek ◽  
Sina Ferahman ◽  
Eyup Gemici ◽  
Ahmet Cem Dural ◽  
Turgut Donmez ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
General Surgery ◽  
Emergency Surgery ◽  
Demographic Data ◽  
Control Group ◽  
Surgical Emergencies ◽  
Mechanical Intestinal Obstruction ◽  
Number Of Patients ◽  
Uncomplicated Appendicitis ◽  
Surgery Department

Abstract Purpose: We aimed to investigate the effect of COVID-19 pandemic on general surgical emergencies. On the other hand, we analyzed the effectiveness of the measures we have taken and the incidence of COVID-19 of patients and healthcare professionals.Method: In the pandemic period between March 14 and May 15, 2020, and in the same period of the previous year, the files of patients who underwent emergency surgery and followed up nonoperatively were reviewed retrospectively. The incidence of COVID-19 was questioned in patients operated on in the pandemic period and in health professionals working in the general surgery department.Results: Demographic data were similar between the two groups. The number of patients operated on in the pandemic group (n = 103) was lower than during the control group (n = 252) (p = 0.001). In the pandemic group, there was a significant decrease in the number of surgeries of uncomplicated appendicitis, acute cholecystitis and incarcerated hernia (p=0.001, p=0.005, p=0.001, respectively). Others surgeries were similar in both groups. In the pandemic group, nonoperatively follow-up rates were significantly lower in acute mechanical intestinal obstruction and acute cholecystitis (p=0.001, p=0.011, respectively). The findings of COVID-19 were positive in 6(6/103, %5.82) patients undergoing emergency surgery. None of our doctors had COVID-19 infection (0/20). The findings were positive only in 2 nurses from the general surgery department(2/24, %8,33).Conclusion: In these and similar pandemics, we think that a new algorithm is needed to approach emergencies and the results of this study can help for that.

scholarly journals The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesco A. Ciarleglio ◽  
Marta Rigoni ◽  
Liliana Mereu ◽  
Cai Tommaso ◽  
Alessandro Carrara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Transfusion ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Close Correlation ◽  
Negative Effects ◽  
Group 2 ◽  
Retrospective Comparative Study ◽  
The Impact ◽  
Group 1

Abstract Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

scholarly journals A Retrospective 05 Years Analysis of Operated Surgical Patients in Bangladesh Level II Hospital, UNMIL

2014 ◽  
Vol 9 (1) ◽  
pp. 14-18
Author(s):  
MB Uddin ◽  
MU Ahmed ◽  
MA Haque ◽  
MD Hussain ◽  
SME Hossain
Keyword(s):  
Surgical Care ◽  
Armed Forces ◽  
Published Data ◽  
Optimal Outcome ◽  
Level Ii ◽  
Number Of Patients ◽  
Minor Surgery ◽  
Surgical Conditions ◽  
Logistic Support ◽  
The Impact

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19

scholarly journals Monitoring inner London mental illness services

1995 ◽  
Vol 19 (5) ◽  
pp. 276-280 ◽  
Author(s):  
◽  
Bernard Audini ◽  
Michael Crowe ◽  
Joan Feldman ◽  
Anna Higgitt ◽  
...  
Keyword(s):  
Mental Illness ◽  
Psychiatric Care ◽  
Bed Occupancy ◽  
Local Data ◽  
Catchment Population ◽  
The Poor ◽  
Number Of Patients ◽  
The Mean ◽  
Acute Psychiatric Care ◽  
The Impact

Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.

scholarly journals Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1185
Author(s):  
Eleni Karlafti ◽  
Emmanouil S. Benioudakis ◽  
Daniel Paramythiotis ◽  
Konstantinos Sapalidis ◽  
Georgia Kaiafa ◽  
...  
Keyword(s):  
General Surgery ◽  
Control Period ◽  
Mortality Rates ◽  
Common Type ◽  
First Year ◽  
Emergency General Surgery ◽  
Time Periods ◽  
Surgery Department ◽  
The Impact ◽  
Type Of Surgery

Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.

scholarly journals SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward Hardy ◽  
Thomas Smart ◽  
Jacob Hatt ◽  
Jon Lund
Keyword(s):  
Length Of Stay ◽  
Perceived Stress ◽  
General Surgery ◽  
Surgical Care ◽  
Emergency General Surgery ◽  
Quality Of Patient Care ◽  
Stress Levels ◽  
General Surgeons ◽  
The Impact

Abstract Aims General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS). Methods Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change. Results 89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care. There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, &gt;4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, &gt; 4D 35%). Conclusions A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.

scholarly journals “Is surgery delayed surgery denied?”- How we managed hepatobiliary pancreatic surgeries among Bangladeshi patients during COVID-19 era

2020 ◽  
pp. 63-70
Author(s):  
Hashim Rabbi ◽  
Md Mamunur Rashid ◽  
AHM Tanvir Ahmed ◽  
HA Nazmul Hakim ◽  
Ajmal Quader Chowdhury ◽  
...  
Keyword(s):  
General Hospital ◽  
Management Strategy ◽  
Virus Disease ◽  
Imaging Techniques ◽  
Management Strategies ◽  
Surgical Care ◽  
Successful Outcome ◽  
Number Of Patients ◽  
Management Approaches ◽  
Surgery Department

Background: Corona virus disease 2019 (COVID-19) is a disease entity caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS COV-2). Although it is not a surgical disease, it significantly influences the management of surgical illness in many ways. Delaying the surgery may be considered as denying the treatment. Authorities all over the world formulated different guidelines and recommendations. Considering current pandemic situation and our patients, we are performing surgeries following our hospital and departmental protocol. Delaying the surgery may negate the treatment and may influence the overall outcome that seem like justice delayed justice denied. Methods: In this prospective observational study, we observed different management approaches to 100 Bangladeshi individuals with hepatobiliary and pancreatic surgical disorders from April 2020 to September 2020, in BIRDEM General Hospital and other hospitals of Dhaka. Patients were thoroughly screened, evaluated and prepared to plan the appropriate management strategy. They were triaged according to presentation and were managed accordingly. Patients consented were only enrolled in this study. Results: The study includes 100 consecutive patients between ages of 21 and 70 years, of them, 77 patients were 4th and 6th decade and only 11 patients (11%) were in 3rd decade of life. Highest 28 patients (28%) were in between 40-49 years and 26 patients in 50-59 years age group. We found 48 patients (48 %) were male and 52 patients (52%) were female. Study showed a slight female predominance and presented at an earlier age than male. The pandemic has created a panic in the society, we were getting less number of patients for HPB surgery in March. Since the end of April 2020 onwards and from July, August and September we have performed 39 surgeries. Conclusion: This article is based on real-time experiences of Hepato-biliary-Pancreatic surgery department of BIRDEM General Hospital and BRB hospitals, Dhaka by the same surgical team. Our experience with COVID-19 positive surgical patients is not gratifying. Modern imaging techniques ensure early detection with better understanding of magnitude of disease, which is essential for proper treatment planning.. Both elective and emergency surgeries can be performed safely with proper precautions. Patients with bridging procedures responded well to planed definitive management. Strategies like neoadjuvant therapy and endotherapies for planned definitive surgical care ensures promising results. Postoperative pneumonia in COVID-19 detected patients is a challenging complication. Optimal management strategy requires a multidisciplinary approach for successful outcome. Birdem Med J 2020; 10, COVID Supplement: 63-70

Emergency surgery (DRAFT)

2018 ◽  
Author(s):  
Jonathan Wild ◽  
Emma Nofal ◽  
Imeshi Wijetunga ◽  
Antonia Durham Hall
Keyword(s):  
General Surgery ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Trauma Surgery ◽  
Emergency Operation ◽  
Emergency General Surgery ◽  
Symptom Palliation ◽  
The Impact ◽  
Theatre List

Emergency general surgery comprises patients with surgical problems requiring surgical intervention or post-operative surgical patients who require further surgical intervention or symptom palliation at any time of the day or night. Beyond the cases discussed below, this will include also emergency presentations from all of the sub-specialty chapters covered so far. Over 600,000 emergency hospital admissions are made to general surgery. Of these patients, they comprise the sickest patient cohort relative to the majority of elective patients, which results from sepsis, shock, or organ dysfunction from the underlying causative pathology, as well as the impact of any pre-existant comorbid states. This often has a significant impact on patient outcome, with high rates of morbidity and mortality relative to elective surgery. With this in mind, a lot of work has been channelled into improving outcomes for these patients. Furthermore, emergency and trauma surgery is beginning to establish itself as a subspecialty in itself. This chapter starts by making applied discussion of the assessment and initial investigation of acute abdominal pain, a complaint that comprises half of the annual 600,000 emergency general surgical admissions. It covers the pertinent features of diagnosis, investigation, and management of a range of common or serious emergency surgical and trauma cases that will be encountered on the acute surgical take. Kidney transplantation is not in itself an emergency operation when you consider the degree of pre-operative preparation of recipient donors, but is included in this chapter as it is commonly encountered by junior trainees on the emergency theatre list when donors are found at short notice.

scholarly journals Impact of the SARS-CoV-2 pandemic on emergency surgery services—a multi-national survey among WSES members

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Martin Reichert ◽  
◽  
Massimo Sartelli ◽  
Markus A. Weigand ◽  
Christoph Doppstadt ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Elective Surgery ◽  
Perforated Appendicitis ◽  
Surgical Patients ◽  
Patient Treatment ◽  
Surgical Patient ◽  
Structural Problems ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
The Impact

Abstract Background The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.

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