The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

2021 ◽  
pp. 039156032110628
Author(s):  
Wissam Abou-Chedid ◽  
Gregory J Nason ◽  
Andrew T Evans ◽  
Kohei Yamada ◽  
Dimitrios Moschonas ◽  
...  
Keyword(s):  
High Volume ◽  
Annual Number ◽  
Clinical Activity ◽  
Prostate Brachytherapy ◽  
Robotic Assisted ◽  
Period 2 ◽  
Urological Oncology ◽  
Number Of Patients ◽  
Oncology Centre ◽  
The Impact

Introduction: The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. Methods: A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017–2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a ‘clean’ site. Results: The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. Conclusion: There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as ‘clean’ sites can ensure continuity of care for cancer surgery and training needs.

scholarly journals Impact of the COVID-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
V. Crenn ◽  
M. El Kinani ◽  
G. Pietu ◽  
M. Leteve ◽  
M. Persigant ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Patient ◽  
Musculoskeletal Injuries ◽  
University Hospital ◽  
Surgical Indications ◽  
Patient Admissions ◽  
Period 2 ◽  
Number Of Patients ◽  
Hospital Transfer ◽  
The Impact

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the 4-week pre-lockdown period and the 8-week lockdown period divided into two 4-week periods: early lockdown and late lockdown. There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19s wave lockdown.

scholarly journals COVID-19 pandemic: Impact on the management of patients with hepatocellular carcinoma at a tertiary care hospital

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256544
Author(s):  
Katharina Pomej ◽  
Bernhard Scheiner ◽  
Lukas Hartl ◽  
Lorenz Balcar ◽  
Tobias Meischl ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Patient Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Median Number ◽  
Care Hospital ◽  
Period 2 ◽  
Number Of Patients ◽  
Tumor Boards ◽  
The Impact

Background Patients with hepatocellular carcinoma (HCC) represent a vulnerable population potentially negatively affected by COVID-19-associated reallocation of healthcare resources. Here, we report the impact of COVID-19 on the management of HCC patients in a large tertiary care hospital. Methods We retrospectively analyzed clinical data of HCC patients who presented at the Vienna General Hospital, between 01/DEC/2019 and 30/JUN/2020. We compared patient care before (period 1) and after (period 2) implementation of COVID-19-associated healthcare restrictions on 16/MAR/2020. Results Of 126 patients, majority was male (n = 104, 83%) with a mean age of 66±11 years. Half of patients (n = 57, 45%) had impaired liver function (Child-Pugh stage B/C) and 91 (72%) had intermediate-advanced stage HCC (BCLC B-D). New treatment, was initiated in 68 (54%) patients. Number of new HCC diagnoses did not differ between the two periods (n = 14 vs. 14). While personal visits were reduced, an increase in teleconsultation was observed (period 2). Number of patients with visit delays (n = 31 (30%) vs. n = 10 (10%); p = 0.001) and imaging delays (n = 25 (25%) vs. n = 7 (7%); p = 0.001) was higher in period 2. Accordingly, a reduced number of patients was discussed in interdisciplinary tumor boards (lowest number in April (n = 24), compared to a median number of 57 patients during period 1). Median number of elective/non-elective admissions was not different between the periods. One patient contracted COVID-19 with lethal outcome. Conclusions Changes in patient care included reduced personal contacts but increased telephone visits, and delays in diagnostic procedures. The effects on long-term outcome need to be determined.

scholarly journals Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karl H. Hillebrandt ◽  
Sebastian Knitter ◽  
Lea Timmermann ◽  
Matthäus Felsenstein ◽  
Christian Benzing ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
The Elderly ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Number Of Patients ◽  
Group 2

Abstract Background Robotic-assisted pancreatic surgery (RPS) has fundamentally developed over the past few years. For subgroups, e.g. elderly patients, applicability and safety of RPS still needs to be defined. Given prognosticated demographic developments, we aim to assess the role of RPS based on preoperative, operative and postoperative parameters. Methods We included 129 patients undergoing RPS at our institution between 2017 and 2020. Eleven patients required conversion to open surgery and were excluded from further analysis. We divided patients into two groups; ≥ 70 years old (Group 1; n = 32) and < 70 years old (Group 2; n = 86) at time of resection. Results Most preoperative characteristics were similar in both groups. However, number of patients with previous abdominal surgery was significantly higher in patients ≥ 70 years old (78% vs 37%, p < 0.0001). Operative characteristics did not significantly differ between both groups. Although patients ≥ 70 years old stayed significantly longer at ICU (1.8 vs 0.9 days; p = 0.037), length of hospital stay and postoperative morbidity were equivalent between the groups. Conclusion RPS is safe and feasible in elderly patients and shows non-inferiority when compared with younger patients. However, prospectively collected data is needed to define the role of RPS in elderly patients accurately. Trial registration Clinical Trial Register: Deutschen Register Klinischer Studien (DRKS; German Clinical Trials Register). Clinical Registration Number: DRKS00017229 (retrospectively registered, Date of Registration: 2019/07/19, Date of First Enrollment: 2017/10/18).

scholarly journals The impact of the COVID-19 pandemic on cardiology services

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001359 ◽  
Author(s):  
Omar Fersia ◽  
Sue Bryant ◽  
Rachael Nicholson ◽  
Karen McMeeken ◽  
Carolyn Brown ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Service Provision ◽  
Recovery Phase ◽  
Community Services ◽  
Outpatient Clinics ◽  
Clinical Activity ◽  
Single Centre ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

ObjectiveThe COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity.MethodsWe analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision.ResultsThere has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation.ConclusionsAs ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.

scholarly journals The impact of a dedicated contact centre on the clinical outcome of patients with inflammatory bowel disease during the COVID-19 outbreak

2020 ◽  
Vol 13 ◽  
pp. 175628482095958
Author(s):  
Olga Maria Nardone ◽  
Antonio Rispo ◽  
Anna Testa ◽  
Nicola Imperatore ◽  
Lucienne Pellegrini ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clinical Outcomes ◽  
Bowel Disease ◽  
High Volume ◽  
Clinical Activity ◽  
Phone Calls ◽  
Inflammatory Bowel ◽  
Contact Centre ◽  
The Impact

Background: With the interruption of elective activity during the coronavirus disease 2019 (COVID-19) pandemic, a reorganisation of health care for patients with inflammatory bowel disease (IBD) was warranted. We aimed to investigate the effectiveness of a dedicated contact centre service (CCS) on the reorganization of a high-volume IBD centre and on the continuity of care during the COVID-19 outbreak. Methods: We compared the CCS services provided to 3680 IBD patients and clinical outcomes before (January–February 2020) and during (March–April 2020) the COVID-19 period. We further included, as comparator, data from March to April of the previous year (2019). Results: During the outbreak, the CCS received an increase of 10.2% of contacts, from 881, in January–February 2020, to 971 ( p = 0.02). An increase of 6% in CCS activities was also reported in comparison with March–April 2019 (from 914 to 971 in March–April 2020, p = 0.71). Before COVID-19, in both periods most contacts (67% in January–February 2020 and 60% in March–April 2019) required information about clinical activity, while fewer (33% in January–February 2020 and 40% in March–April 2019) requested logistic information. During the pandemic, most contacts (65.1%) asked to speak with a physician, 23.7% asked for information, while 11.1% wanted to cancel/postpone their appointments. Among all the information, 66% concerned COVID-19. In March–April 2020, 259 outpatient visits were booked, but were all replaced by phone consultations. No difference was detected in the number of intravenous biological administrations (307 versus 296, p = 0.64), surgeries (10 versus 9, p = 0.82) and urgent hospitalisations (10 versus 12, p = 0.67) before and during the COVID-19. Conclusion: The CCS was an effective tool in the reorganization of the IBD centre. Scheduled visits were replaced by phone calls. The main clinical outcomes were maintained in the COVID-19 period. Virtual follow-up using the CCS could be implemented after the pandemic to optimise the resources of the IBD centre.

Measuring the Impact of Multidisciplinary Care on Quality for Pancreatic Surgery: Transition to a Focused, Very High-volume Program

2013 ◽  
Vol 79 (8) ◽  
pp. 775-780 ◽  
Author(s):  
Timothy L. Fitzgerald ◽  
Noah M. Seymore ◽  
Swapnil D. Kachare ◽  
Emmanuel E. Zervos ◽  
Jan H. Wong
Keyword(s):  
Pancreatic Surgery ◽  
Multidisciplinary Care ◽  
High Volume ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
N 93 ◽  
The Impact ◽  
Over Time ◽  
Group 1

Outcomes are superior for pancreatic resection at high-volume centers. To assess the impact of focused high-volume multidisciplinary care, a quality index (QI) was used to review our experience. Data from 1996 to July 2012 were analyzed in three groups: 1) early (1996 to 2007); 2) transition (2008 to 2009); and 3) mature (2010 to July 2012). A total of 239 patients were included with a mean age of 63.4 years and the majority were white (65.7%). The number of patients with Charlson comorbidity index greater than 2 and age older than 80 years increased comparing Group 1 with latter groups. Volume increased over time: Group 1 (n = 93) 7.75/year, Group 2 (n = 51) 25.5/year, and Group 3 (n = 95) 39/year. Overall mortality was 5.9 per cent: Group 1, 4.3 per cent; Group 2, 11.5 per cent; and Group 3, 3.9 per cent ( P = 0.0454). The QI score incorporates documentation, chemotherapy, resection for Stage I/II, time to treatment, margins, lymph nodes, mortality, and surgical volume with a maximum possible score 10. The QI increased over time: 3 in Group 1; 4 in Group 2; and 6 in Group 3. An improvement was noted for the quality indicators: surgical resection ( P = 0.0125) and use of palliative and adjuvant therapy ( P = 0.0144 and < 0.0001). Implementation of a focused multidisciplinary pancreatic surgery program increases quality.

Conceptualization of an indication-specific pricing model to assess potential savings to a U.S. health plan.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18315-e18315 ◽  
Author(s):  
Sandip Shah ◽  
Joseph Black ◽  
Vidya Ramesh ◽  
Dong Shao ◽  
Siva Narayanan
Keyword(s):  
Health Plan ◽  
Compliance Rate ◽  
Unmet Need ◽  
Annual Number ◽  
Selling Price ◽  
Public Attention ◽  
Her2 Breast Cancer ◽  
Number Of Patients ◽  
Support Price ◽  
The Impact

e18315 Background: Value based pricing has become a topic of increasing public attention and scrutiny. An Indication Specific Pricing (ISP) allows price setting relative to the level of benefit provided in a given indication and patient population, with the potential for price to vary based on value in the concerned indication(s). We quantified the impact of deploying an ISP scheme on 5-year Afinitor (everolimus) expenditures for a hypothetical health plan of 5M covered lives in the U.S., taking into account three indications: HER2- breast cancer, renal cell carcinoma, and pancreatic cancer. Methods: We constructed an Excel-based model to understand future expenditures on an annual basis utilizing an ISP scheme against a more traditional single contracted price. Key inputs for the model include price per pill (average selling price (ASP)), forecasted annual number of patients per indication (based on 5M covered lives), and compliance rate. Results from the Sloan Kettering “DrugAbacus” pricing project were leveraged to estimate indication-level prices based on their assessment of efficacy, tolerability, and unmet need for Afinitor in each of the indications; actual ISP prices originally used by Sloan Kettering in their model were reweighted and adjusted. Results: As the DrugAbacus price calculated for each indication was lower than the current ASP for Afinitor, use of an ISP methodology resulted in a 9.3% decrease in five year expenditures for Afinitor ($136.9M for a traditional single price vs. $124.1M for an ISP model). Conclusions: US Payers could consider assessing the value a therapeutic intervention brings to each approved indication using ISP in an effort to lower total pharmaceutical-related healthcare costs. Drug manufacturers may benefit from considering relative product value in each potential indication to assess commercial attractiveness and focus evidence generation strategies on those indications seen as most valuable, to support price negotiations.

P14.40 Trends in distribution of glioblastoma care and patient’s travel distance; results from the Dutch Brain Tumor Registry

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii46-ii46
Author(s):  
M E De Swart ◽  
V K Y Ho ◽  
F J Lagerwaard ◽  
D Brandsma ◽  
M P Broen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
The Netherlands ◽  
High Volume ◽  
Travel Distance ◽  
Tumor Registry ◽  
Number Of Patients ◽  
Oncology Care ◽  
Time Periods ◽  
The Impact ◽  
Travel Distances

Abstract BACKGROUND Over the past years, increasing worldwide attention towards centralization of complex cancer care has been pursued as higher volume centers have shown improved outcomes. Changes in distribution of care and the impact on travel distance in glioblastoma patients have not been determined yet. In this study, we determine trends in distribution of glioblastoma care in the Netherlands over the last three decades and assess whether the observed trends affected travel distance for individual patients. MATERIAL AND METHODS Data were obtained from the Dutch Brain Tumor Registry from 1989 to 2018. All glioblastoma patients (≥18 years) were included for analysis. Patients, neurosurgical centers and radiotherapy centers were geocoded. Data were analyzed in six time intervals of 5 years. High volume hospitals were defined as &gt;50 cases per year. Travel distance was examined in two categories, ≤60km and &gt;60km respectively. Trend analyses for proportions were used to analyze hospital volume changes and travel distances. RESULTS A total of 16.477 glioblastoma patients were registered, with an annual increase from 203 patients in 1989 to 917 patients in 2018. Neurosurgical centers increased from 16 to 17 and for radiotherapy from 19 to 22 centers between 1989–1993 and 2014–2018. Mean neurosurgical- and radiotherapy center volumes increased from 12 to 39 (P=0.025) and 7 to 27 (P=0.025) patients per hospital per year from 1989–1993 to 2014–2018. High volume neurosurgical centers were observed since 2004, and an increased number of patients were treated in these centers, 27.8%, 52.6% and 64.1% in the time periods 2004–2008, 2009–2013, and 2014–2018 (P&lt;0.001). High volume radiology centers were observed since 2009, and 15.0% and 27.3% of patients were treated in these centers in the time periods 2009–2013 and 2014–2018 (P&lt;0.001). Patients with a travel distance &gt;60km to the neurosurgical center reduced from 15.8% to 13.2% (P=0.033). Travel distance &gt;60km to the radiotherapy center did not reduce significantly (10.4% to 8.8%, P=0.601). CONCLUSION An increasing number of glioblastoma patients were differentially treated in high volume neurosurgery and radiotherapy centers. The observation that this did not translate into increased travel distances, indicates accessible specialized Neuro-Oncology care for glioblastoma patients in The Netherlands.

scholarly journals Treatment beyond progression with anti-PD-1/PD-L1 based regimens in advanced solid tumors: a systematic review

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesco Spagnolo ◽  
Andrea Boutros ◽  
Federica Cecchi ◽  
Elena Croce ◽  
Enrica Teresa Tanda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Solid Tumor ◽  
Progressive Disease ◽  
Partial Information ◽  
Clinical Activity ◽  
Advanced Solid Tumor ◽  
Fda Approval ◽  
Number Of Patients ◽  
Treatment Beyond Progression ◽  
The Impact

Abstract Background Treatment beyond progression with immunotherapy may be appropriate in selected patients based on the potential for late responses. The aim of this systematic review was to explore the impact of treatment beyond progression in patients receiving an anti-PD-1/PD-L1 based regimen for an advanced solid tumor. Methods A systematic literature search was performed to identify prospective clinical trials reporting data on overall response rate by immune-related criteria and/or the number of patients treated beyond conventional criteria-defined PD and/or the number of patients achieving a clinical benefit after an initial PD with regimens including an anti-PD-1/PD-L1 agent which received the FDA approval for the treatment of an advanced solid tumor. Results 254 (4.6%) responses after an initial RECIST-defined progressive disease were observed among 5588 patients, based on 35 trials included in our analysis reporting this information. The overall rate of patients receiving treatment beyond progressive disease was 30.2%, based on data on 5334 patients enrolled in 36 trials, and the rate of patients who achieved an unconventional response among those treated beyond progressive disease was 19.7% (based on 25 trials for a total of 853 patients). Conclusion The results of our systematic review support the clinical relevance of unconventional responses to anti-PD-1/PD-L1-based regimens; however, most publications provided only partial information regarding immune-related clinical activity, or did not provide any information at all, highlighting the need of a more comprehensive report of such data in trials investigating immunotherapy for the treatment of patients with advanced tumors.

scholarly journals Impact of the Covid-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

2020 ◽  
Author(s):  
Vincent Crenn ◽  
Monia El Kinani ◽  
Guy Pietu ◽  
Leteve Marie ◽  
Mike Persigant ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Patient ◽  
Musculoskeletal Injuries ◽  
University Hospital ◽  
Surgical Indications ◽  
Patient Admissions ◽  
Period 2 ◽  
Number Of Patients ◽  
Hospital Transfer ◽  
The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. Methods We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the four-week pre-lockdown period and the eight-week lockdown period divided into two four-week periods: early lockdown and late lockdown. Results There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). Conclusion A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19 second wave lockdown.

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