scholarly journals EP.WE.93An Overview of the Effect of COVID-19 on the General Surgical Take: Before, During and After the First UK National Lockdown

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rachel Heard ◽  
Maja Kopczynska ◽  
Michal Woyton ◽  
Elizabeth Allen ◽  
Madeline Garcia ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Conservative Management ◽  
Demographic Data ◽  
Surgical Pathology ◽  
Large Decrease ◽  
Very Elderly ◽  
Data Treatment ◽  
National Guidance ◽  
New Challenges ◽  
Surgical Conditions

Abstract Aims Emergency general surgical (EGS) services have faced new challenges during the coronavirus pandemic. This study compared all EGS presentations before, during and after the first UK national lockdown between March and May 2020. Methods All EGS patients presenting to our centre in four separate weeks were included. These weeks represented ‘pre-lockdown’, ‘early lockdown’, ‘established lockdown’ and ‘post lockdown’ groups. Demographic data, treatment, admission and outcomes were collected for all patients and compared between groups. Results 178 patients accounted for 214 EGS attendances over four weeks. Attendances decreased from 74 pre-lockdown, to 43 in early lockdown, 32 in late lockdown and rose to 65 in the post lockdown group. Significantly more patients received repeat outpatient reviews in the lockdown groups (p = 0.002). Length of stay was significantly reduced in established lockdown (0.5 days vs. 2 days pre-lockdown, p = 0.042). There was a trend towards conservative management of surgical pathology in the lockdown groups (65% vs 47% pre and post-lockdown, p = 0.10). No very elderly or frail EGS patients presented during the lockdown study period. There was no evidence of delay to presentation. Conclusions The COVID-19 pandemic and UK Coronavirus lockdown resulted in a large decrease in EGS admissions and alteration in characteristics of these admissions. New national guidance during the pandemic advocated ambulatory and conservative management of surgical conditions where possible and is reflected in our cohort. These changes reverted almost back to pre-lockdown state the week following the easing of the first UK national lockdown.

scholarly journals 746 COVID-19: Changing the Future of Emergency Epistaxis Management

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Y Devabalan
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Conservative Management ◽  
Demographic Data ◽  
Outpatient Management ◽  
Single Centre ◽  
Airway Emergency ◽  
Haemostatic Agents ◽  
Standard Operating ◽  
Life Threatening

Abstract Introduction Acute epistaxis can be a life-threatening airway emergency. Therefore, the majority of patients in whom conservative management (including cautery) has failed are admitted. However, due to the COVID-19 pandemic, our management has shifted towards a more outpatient centred approach. Method A single centre retrospective study was undertaken of all epistaxis patients managed by the ENT team at our centre over a five-month period from 1st January to 31st May 2020. The first 10 weeks (Pre-COVID-19) were managed using pre-existing guidelines. The following 10 weeks (COVID-19) were managed using the new COVID-19 standard operating procedures which aimed to minimise inpatient admissions. Results 142 patients, with similar demographic data, were seen across the 5-month period. There were significantly more patients aged over 65 presenting in the COVID-19 group (p = 0.04). There was a significantly increased use of local haemostatic agents (Nasopore ® and Surgiflo ®) and decreased use of nasal packing in the COVID-19 group. There were significantly fewer admissions (p < 0.0005) in the COVID-19 group, but similar rates of representation, length of stay and morbidity. Conclusions The COVID-19 pandemic has accelerated the shift towards the use of local haemostatic agents and outpatient management of epistaxis, which is as safe and effective as previously well-established epistaxis management.

scholarly journals Time trends in hospital discharges in patients aged 85 years and older in Spain: data from the Spanish National Discharge Database (2000–2015)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sergio Palacios-Fernandez ◽  
Mario Salcedo ◽  
Gregorio Gonzalez-Alcaide ◽  
Jose-Manuel Ramos-Rincon
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Age Groups ◽  
Percentage Increase ◽  
Very Elderly ◽  
Hospital Discharges ◽  
Data Set ◽  
Common Causes ◽  
Discharged Patients ◽  
Hospital Systems

Abstract Background The aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015. Methods Retrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends. Results There were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000–2003 and 10.42% in 2012–2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85–89 years, 7.79% in those aged 90–94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001). The proportion of patients that died during hospital admission decreased from 14.64% in 2000–2003 to 13.83% in 2012–2015 (p < 0.001), and mean length of stay from 9.98 days in 2000–2003 to 8.34 days in 2012–2015. Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%). Conclusions Discharges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge.

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

scholarly journals P067: Factors associated with prolonged length of stay of admitted patients in a tertiary care emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S101
Author(s):  
K. Johns ◽  
S. Smith ◽  
E. Karreman ◽  
A. Kastelic
Keyword(s):  
Length Of Stay ◽  
Multiple Regression ◽  
Significant Relationship ◽  
Demographic Data ◽  
Healthcare Access ◽  
Tertiary Care ◽  
Outcome Variable ◽  
Prolonged Length ◽  
Patient Demographic Data ◽  
Major Predictor

Introduction: Extended length of stay (LOS) in emergency departments (EDs) and overcrowding are a problems for the Canadian healthcare system, which can lead to the creation of a healthcare access block, a reduced health outcome for acute care patients, and decreased satisfaction with the health care system. The goal of this study is to identify and assess specific factors that predict length of stay in EDs for those patients who fall in the highest LOS category. Methods: A total of 130 patient charts from EDs in Regina were reviewed. Charts included in this study were from the 90th-100th percentile of time-users, who were registered during February 2016, and were admitted to hospital from the ED. Patient demographic data and ED visit data were collected. T-tests and multiple regression analyses were conducted to identify any significant predictors of our outcome variable, LOS. Results: None of the demographic variables showed a significant relationship with LOS (age: p=.36; sex: p=.92, CTAS: p=.48), nor did most of the included ED visit data such as door to doctor time (p=.34) and time for imaging studies (X-ray: p=.56; ultrasound: p=.50; CT p=.45). However, the time between the request for consult until the decision to admit did show a significant relationship with LOS (p&lt;.01).Potential confounding variables analyzed were social work consult requests (p=.14), number of emergency visits on day of registration (p=.62), and hour of registration (00-12 or 12-24-p&lt;.01). After adjustment for time of registration, using hierarchical multiple regression, time from consult request to admit decision maintained a significant predictor (p&lt;.01) of LOS. Conclusion: After adjusting for the influence of confounding factors, “consult request to admit decision” was by far the strongest predictor of LOS of all included variables in our study. The results of this study were limited to some extent by inconsistencies in the documentation of some of the analyzed metrics. Establishing standardized documentation could reduce this issue in future studies of this nature. Future areas of interest include establishing a standard reference for our variables, a further analysis into why consult requests are a major predictor, and how to alleviate this in the future.

scholarly journals Management of appendicitis during COVID-19 pandemic; short-term outcomes

2020 ◽  
Vol 65 (4) ◽  
pp. 144-148
Author(s):  
Radhakrishnan Ganesh ◽  
James Lucocq ◽  
Neville Ogbonnia Ekpete ◽  
Noor Ul Ain ◽  
Su Kwan Lim ◽  
...  
Keyword(s):  
Conservative Management ◽  
Short Term ◽  
Mri Scan ◽  
Operative Outcomes ◽  
Uncomplicated Appendicitis ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Surgical Conditions

Background and aim COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. Methods Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. Results One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. Conclusion CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.

scholarly journals Characteristics, Comorbidities, and Outcomes Among Patients Admitted With COVID-19 in Sheikh Khalifa Medical City: A Retrospective Study

2021 ◽  
Author(s):  
Moustafa Abdelwahab ◽  
Lara Al Qadi ◽  
Mohammad Al Jawabreh ◽  
Hanan Sulaiman ◽  
Mariam Al Blooki
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Case Series ◽  
Minimum Length ◽  
Diabetic Patients ◽  
Upper Respiratory Tract ◽  
Medical City

Abstract Background: Many studies were published to describe the clinical characteristics of COVID-19, however there is still lack of knowledge and it’s time to take stock of the war against coronavirus disease 2019 (COVID-19) pandemic before we hit another million in a matter of days. Simply Identifying COVID-19 features will help in mapping the disease and guiding pandemic management. A retrospective review, retrospective study was initiated in SKMC to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases who were hospitalized during that period.Methods: Confirmed positive COVID-19 sample patients from April 1st 2020 to May 31st 2020 in Sheikh Khalifa Medical City. Clinical characteristics, Demographic data, incubation periods, laboratory findings, and patient outcomes data retrieved from 336 cases in the electronic medical chart (SALAMTAK).Results: The median age was 44 years and 83.9% (n = 282) of the patients were men. The patients with diabetes mellitus being the most common risk factor (25.0%), followed by hypertension (22.9%) and Age ≥60 were (13.4%). Total 36 patients (10.7%) were asymptomatic. The most common symptoms were upper respiratory tract symptoms, manifested as dry cough (70.2%), and followed by fever (54.2%), shortness of breath (43.5%), headache (25.9%) and sore throat (25.3%). Less common symptoms were diarrhea (16.7%) chest pain (14.6%). The maximum length of stay is 32 days. The minimum length of stay in [ICU/HDU] was 1 day and the maximum was 21 days.Conclusion: In this retrospective study, fever and cough were common symptoms. Special attention should be given to patients with risk factors especially patients with one risk factor such as diabetic patients, patients with hypertension and older patients over 60 years as they are the most highly prevalent in this case series. Disease was affecting males and D-dimer was significantly elevated in deceased patients.

scholarly journals How does mother's working status and number of siblings affect school age child trauma presenting to the emergency department

2019 ◽  
Vol 8 (1) ◽  
pp. 71
Author(s):  
Serkan Dogan ◽  
Ekim Saglam Gurmen ◽  
Melis Dorter ◽  
Utku Murat Kalafat ◽  
Busra Bildik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Demographic Data ◽  
Child Trauma ◽  
School Age ◽  
Age Group ◽  
Trauma Mechanism ◽  
Working Status ◽  
Tissue Trauma ◽  
Out Of School

 Background: The aim of this study was to investigate the effects of mother working status and siblings on school-age child trauma admitted to the emergency department and to investigate school-age traumas.Methods: This prospective study was conducted with the approval of the ethics committee in the emergency department of a training and research hospital. All demographic data of the school-aged children (66 months-18 years) who applied to the emergency department, the location of the trauma, the mechanism of occurrence, the mother's working status, the presence and number of siblings, the duration of stay in the emergency department, clinical outcome and hospital service cost were recorded.Results: A total of 794 children were included in the study. 263(33.1%) were girls and 531(66.9%) were boys. Soft tissue trauma was the most common (94.3%). The place of the trauma was 62.7% out of school and 37.3% in school. When mother working conditions were analyzed, it was seen that 34.2% did not work. 97.1% of the children had one or more siblings. The most common trauma mechanism (65.6%) was collision and the second (60.6%) was falls. 99.1% of the patients were discharged. The length of stay in the emergency department of the Grade-schooler age group was higher than the Teen age group (p: 0,000). The length of stay in emergency department was higher in patients without siblings (p: 0.017). It was observed that those whose mothers did not work remained in the emergency room longer (p: 0,000). It was found that the ones whose mothers did not work mostly came with trauma mechanism as a result of falling (65.4%) (p: 0.044).Conclusions: Providing education for protection from accidents in schools and out of school to all people, especially children, parents and teachers, and making safe playgrounds with solid floors will minimize accident and injury rates and severity levels.

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