Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

Abstract IntroductionThe COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methodsDatasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. ResultsForty-four centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase.ConclusionsOur audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

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668 The Consequences to Emergency Surgery During COVID19 Pandemic in a UK District General Hospital in The North East of England

British Journal of Surgery ◽

10.1093/bjs/znab134.075 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Evans ◽

C Ng

Keyword(s):

Surgical Treatment ◽

General Hospital ◽

Emergency Surgery ◽

Early Identification ◽

District General Hospital ◽

Public Confidence ◽

Surgical Services ◽

North East ◽

The North ◽

Initial Reduction

Abstract Aim COVID19 pandemic has significantly affected surgical services. We aim to review its effects on our theatre output and risk of encountering COVID 19 cases. Method Serial record of operations performed locally were reviewed from start of UK COVID19 pandemic lockdown on 23rd March 2020 to 13th July 2020 after it was lifted. A weekly average by month of operations and the percentage of COVID19 cases diagnosed within 30 days of the procedure were noted. Results 733 operations performed through this period. In March, 33 operations/week performed, 88.4% emergency and 7% diagnosed with COVID19. April, 31 operations /week performed, 95.9% emergency and 10.6% diagnosed with COVID19. May 46 operations /week performed, 94.5% emergency and 3.3% diagnosed with COVID19. June 56 operations /week, 80.9% emergency and less than 0.01% diagnosed with COVID19. By July 80 operations/week, 59.4% emergency and none diagnosed with COVID 19. Since testing capacity increased, only 6 of the 27 operated were diagnosed with COVID19. Conclusions There was initial reduction to non-emergency workload. However, this has gradually shifted as protocols are in place improve public confidence to return for surgical treatment. Mandatory admission testing allows early identification and remains essential for planning of services and protecting the workforce.

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Where is General Paediatric Surgery Going? An Analysis of General Paediatric Surgery in South Wales, 1997–2006

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363512x13189526437676 ◽

2012 ◽

Vol 94 (1) ◽

pp. 1-4

Author(s):

WD Beasley ◽

R Surana

Keyword(s):

Paediatric Surgery ◽

General Hospitals ◽

Surgical Services ◽

Medical Careers ◽

South Wales ◽

Surgical Trainees ◽

Surgical Units ◽

European Working ◽

General Surgeons ◽

Working Practices

Traditionally, general paediatric surgery (GPS) has been delivered by general surgeons, often in district general hospitals (DGHs). Changes to higher training in general surgery as a result of Calmanisation, the European Working Time Regulations and Modernising Medical Careers has meant that fewer general surgical higher trainees are being exposed to GPS Together with changes in paediatric anaesthesia working practices and guidelines, the future delivery of GPS services in DGHs is in jeopardy. The burden on specialist paediatric surgical units (SPSUs) will increase with implications for the training of paediatric surgical trainees. Evidence from England has shown that there has been a shift of paediatric surgical services from DGHs to SPSUs.

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Pilot study of a new paradigm in the management of surgical emergencies using emergency surgery ambulatory care

Bulletin of The Royal College of Surgeons of England ◽

10.1308/rcsbull.2014.96.6.198 ◽

2014 ◽

Vol 96 (6) ◽

pp. 198-201 ◽

Cited By ~ 8

Author(s):

GM Tierney ◽

S Tou ◽

J Hender ◽

JN Lund

Keyword(s):

Pilot Study ◽

Ambulatory Care ◽

Clinical Experience ◽

Emergency Surgery ◽

Medical Staff ◽

Medical Emergency ◽

New Paradigm ◽

Emergency Admissions ◽

Surgical Emergencies ◽

The Uk

The number of emergency admissions to hospital in the UK has been increasing for many years. The cause is multifactorial and relates to increasing population age and associated comorbidity, changes in community medical emergency cover, patient expectations and decreased clinical experience of junior medical staff. Beds occupied by emergency patients within a constrained total lead inevitably to cancellation of procedures for elective patients.

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Acute General Surgical Emergency and COVID-19 Is a Pandemic Challenge for Surgeons: A United Kingdom-Based Practical Experience

Journal of Patient Experience ◽

10.1177/2374373521997735 ◽

2021 ◽

Vol 8 ◽

pp. 237437352199773

Author(s):

Md Abu Kamal Nahid ◽

Sanjida Rahman ◽

Ankur Jyotindra Shah

Keyword(s):

Prospective Observational Study ◽

Perioperative Period ◽

District General Hospital ◽

Practical Experience ◽

Surgical Patients ◽

Secondary Outcome ◽

Global Challenge ◽

Surgical Services ◽

Surgical Emergencies ◽

Surgical Pathway

Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of emergency surgery. A prospective observational study was performed between March 30, 2020, and June 30, 2020, at a large District General Hospital in England. The primary outcome was perioperative COVID-19-related complications, and secondary outcome measures included incidence of COVID-19 infections among the acute surgical patients, doctors, and healthcare workers. A total of 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors and 11 theater staff were confirmed for COVID-19 by swab test. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge, but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.

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Emergency surgery amid ongoing pandemic in suspected COVID-19 with D1 perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20203820 ◽

2020 ◽

Vol 7 (9) ◽

pp. 3169

Author(s):

Mrinal Shankar ◽

Manoj Kumar Chaudhary ◽

Shubham Samal ◽

Radhakrishna Ramchandani

Keyword(s):

Emergency Surgery ◽

Acute Care Surgery ◽

Duodenal Perforation ◽

Rt Pcr ◽

Chain Reaction ◽

Surgical Services ◽

Life Saving ◽

Polymerase Chain ◽

To Come ◽

Care Surgery

The COVID-19 pandemic has affected working patterns of all emergency and regular surgical services. We report a case of emergency surgery amid this ongoing pandemic, in a suspected COVID-19 patient with D1 (duodenal) perforation. We did not wait for the real time polymerase chain reaction (RT-PCR) report for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to come, and proceeded with surgery with all safety protocols. We intend not to delay, for the better outcome of patient’s condition, the life-saving response alike we follow routinely. The pandemic scenario is expected to sustain for longer time. We assume, patients requiring acute care surgery with COVID-19 like symptoms (suspected or confirmed), should definitely be proceeded with surgery as earliest, following all safety protocols, and prevent undue and added morbidity and mortality during this pandemic crisis.

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444 Acute Surgical Admissions at the End of Life: An Analysis of Deaths in Non-operatively Managed Patients

British Journal of Surgery ◽

10.1093/bjs/znab259.829 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

H Clements ◽

M El Boghdady ◽

A Alijani

Keyword(s):

Surgical Intervention ◽

Care Service ◽

Palliative Care Service ◽

Service Planning ◽

Do Not Resuscitate ◽

Bowel Ischaemia ◽

Time To Death ◽

Surgical Emergencies ◽

Data Points ◽

Comorbidity Index

Abstract Aim Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. Method This single-centre retrospective, observational study collected data points for a 12-month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. Results 72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis, or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. Conclusions Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

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Surgery During COVID-19 Era - An Overview

The Physician ◽

10.38192/1.6.2.3 ◽

2020 ◽

Vol 6 (2) ◽

Author(s):

Anil Kumar ◽

Meghana Taggarsi ◽

CR Selvasekar

Keyword(s):

Surgical Training ◽

Emergency Surgery ◽

Online Teaching ◽

Patient Management ◽

Emergency Services ◽

Chest Imaging ◽

Safe Delivery ◽

Surgical Services ◽

Use Of Resources ◽

The Impact

COVID-19 pandemic has affected more than 215 countries worldwide. Patient management has seen a tremendous change in the current pandemic with many specialities adopting measures to contain human to human transmission of the virus and to make judicious use of resources available. Surgical practices have changed globally with the use of virtual consultation, prioritisation of all elective and non-emergency services, COVID swab testing, chest imaging for all patients undergoing surgery and use of PPE to ensure staff safety. A major impact of COVID-19 has been on emergency surgery services and on surgical training. This article highlights the impact of COVID-19 on the safe delivery of surgical services and emphasizes on the use of webinars, online teaching and simulation as a meaningful tool to deliver surgical training in COVID era.

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General Anaesthesia and Emergency Surgery in Heart Transplant Recipient

Case Reports in Surgery ◽

10.1155/2015/256465 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Farshid Ejtehadi ◽

Sharon Carter ◽

Lucy Evans ◽

Mubashar Zia ◽

Howard Bradpiece

Keyword(s):

Transplant Recipient ◽

General Anesthesia ◽

General Anaesthesia ◽

Male Patient ◽

Heart Transplant ◽

Emergency Surgery ◽

Heart Transplant Recipient ◽

Postoperative Monitoring ◽

Surgical Emergencies ◽

Number Of Patients

The number of patients who undergo heart transplant is increasing. Due to surgical emergencies, many of those may require general anesthesia in hospitals where subspecialized anesthetists may not be available. We present a case of a male patient who had heart transplant and required general anesthesia for emergency appendicectomy. Physiology of the heart after transplant, preoperative considerations, and postoperative monitoring has been discussed in our report.

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What factors shape surgical access in West Africa? A qualitative study exploring patient and provider experiences of managing injuries in Sierra Leone

BMJ Open ◽

10.1136/bmjopen-2020-042402 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042402

Author(s):

Amrit Virk ◽

Mohamed Bella Jalloh ◽

Songor Koedoyoma ◽

Isaac O Smalle ◽

William Bolton ◽

...

Keyword(s):

Sierra Leone ◽

Community Outreach ◽

First Aid ◽

Cost Of Care ◽

Supply Side ◽

Demand Side ◽

Surgical Services ◽

Surgical Access ◽

Post Conflict ◽

Medical Facilities

IntroductionSurgical access is central to universalising health coverage, yet 5 billion people lack timely access to safe surgical services. Surgical need is particularly acute in post conflict settings like Sierra Leone. There is limited understanding of the barriers and opportunities at the service delivery and community levels. Focusing on fractures and wound care which constitute an enormous disease burden in Sierra Leone as a proxy for general surgical need, we examine provider and patient perceived factors impeding or facilitating surgical care in the post-Ebola context of a weakened health system.MethodsAcross Western Area Urban (Freetown), Bo and Tonkolili districts, 60 participants were involved in 38 semistructured interviews and 22 participants in 5 focus group discussions. Respondents included surgical providers, district-level policy-makers, traditional healers and patients. Data were thematically analysed, combining deductive and inductive techniques to generate codes.ResultsInteracting demand-side and supply-side issues affected user access to surgical services. On the demand side, high cost of care at medical facilities combined with the affordability and convenient mode of payment to the traditional health practitioners hindered access to the medical facilities. On the supply side, capacity shortages and staff motivation were challenges at facilities. Problems were compounded by patients’ delaying care mainly spurred by sociocultural beliefs in traditional practice and economic factors, thereby impeding early intervention for patients with surgical need. In the absence of formal support services, the onus of first aid and frontline trauma care is borne by lay citizens.ConclusionWithin a resource-constrained context, supply-side strengthening need accompanying by demand-side measures involving community and traditional actors. On the supply side, non-specialists could be effectively utilised in surgical delivery. Existing human resource capacity can be enhanced through better incentives for non-physicians. Traditional provider networks can be deployed for community outreach. Developing a lay responder system for first-aid and front-line support could be a useful mechanism for prompt clinical intervention.

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Improving Surgical Access in Rural Africa through a Surgical Camp Model

Surgery Research and Practice ◽

10.1155/2016/9021945 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

M. Galukande ◽

O. Kituuka ◽

E. Elobu ◽

J. Jombwe ◽

J. Sekabira ◽

...

Keyword(s):

Health Service Delivery ◽

Study Data ◽

Cross Sectional ◽

Surgical Services ◽

Surgical Access ◽

Surgical Residents ◽

Wide Range ◽

Rural Africa ◽

Surgical Teams ◽

Clinical Officers

Introduction. Surgical camps are preplanned activities where volunteer surgical teams congregate at specified place(s) and perform a wide range of mostly elective procedures for a limited period of time. This is usually at no cost to the patients, who belong to vulnerable (poor and hard to reach) communities. We describe a surgical camp model and its challenges as a means of improving access to surgical services.Methods. A cross-sectional descriptive study. Data from a recent Association of Surgeons of Uganda surgical camp were collected and analyzed for demographics, costs, procedure types, and rates and, in addition, challenges encountered and solutions. Personnel that participated in this exercise included specialist surgeons, surgical residents, medical officers, clinical officers, anesthetists, and theater nurses (a total of 121 staff).Results. In total, 551 procedures were performed during a four-day-long camp. Mean age was 35 years (SD 23), M : F ratio was 2 : 1. Herniorrhaphy, skin lump excision, hydrocelectomy, and thyroidectomy formed 81% of all the procedures. Average cost per procedure was $73 USD.Conclusion. Surgical camps offer increased access to surgical services to vulnerable populations. Hernias and goiters were most common. Surgical camps should become an integral part of the Health Service delivery in low-resourced environments.

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