scholarly journals Surgical Interventions in Patients Hospitalised with COVID-19. A Review of Seven Months of Experience Working in a COVID-19 Dedicated Centre

2021 ◽  
Vol 10 (3) ◽  
pp. 395
Author(s):  
Justyna Rymarowicz ◽  
Michał Pędziwiatr ◽  
Piotr Major ◽  
Bryan Donohue ◽  
Karol Ciszek ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Surgical Procedure ◽  
Surgical Care ◽  
Major Surgery ◽  
Surgical Specialty ◽  
Surgical Interventions ◽  
Face To Face ◽  
Overall Mortality

The Coronavirus Disease 2019 (COVID-19) pandemic has made changes to the traditional way of performing surgical consultations. The aim of the present study was to assess the need for surgical care performed by various surgical specialties among patients infected with COVID-19 hospitalized in a COVID-19 dedicated hospital. All surgical consultations performed for patients infected with COVID-19 in a COVID dedicated hospital in a seven month period were evaluated. Data on demographics, surgical specialty, consult reason, procedure performed, and whether it was a standard face to face or teleconsultation were gathered. Out of 2359 COVID-19 patients admitted to the hospital in the seven month period, 229 (9.7%) required surgical care. Out of those 108 consultations that did not lead to surgery, 71% were managed by telemedicine. A total of 36 patients were operated on while suffering from COVID-19. Out of them, only three patients admitted primarily for COVID-19 pneumonia underwent emergency surgery. The overall mortality among those operated on was 16.7%. Conclusions: Patients hospitalised with COVID-19 may require surgical care from various surgical specialties, especially during peaks of the pandemic. However, they rarely require a surgical procedure and only occasionally require major surgery. A significant portion of potentially surgical problems could be managed by teleconsultations.

The Evaluation of the Role of the Cytokines TNF- alfa and IL 6 in the Production of Hypoalbuminemia in Patients Undergoing Major Surgical Interventions

2018 ◽  
Vol 69 (7) ◽  
pp. 1830-1837
Author(s):  
Cristian Nicolescu ◽  
Alaxendru Pop ◽  
Alin Mihu ◽  
Luminita Pilat ◽  
Ovidiu Bedreag ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Tnf Alpha ◽  
Phase Reaction ◽  
Statistical Validation ◽  
Necrosis Factor Alpha ◽  
Surgical Interventions ◽  
Plasmatic Level ◽  
Factor Alpha ◽  
Validation Tests

This article presents an observational randomized prospective study done on 65 patients, who underwent major surgical interventions in the field of orthopedic surgery-total hip replacement or general surgery � total colectomy. The level of albuminemia in these cases were determined before the surgical intervention, after 6 hours of the intervention and after 24 h of the intervention. The measurements of the plasmatic concentration of the pro-inflammatory cytokines Tumor Necrosis factor -alpha (TNF-alpha) and interleukin 6 (IL6) were simultaneously done with the determination of the plasmatic levels of albumin. Values of hemoglobin and hematocrit were determined 24 h after the surgical procedure in order to exclude hemodilution, which could lead to a possible drop in the levels of plasmatic albumin. After the collection of the data, the statistical work was done and it consisted of descriptive statistics, correlation and comparison tests as well as statistical validation tests. Obtained results indicate that IL-6 plays a major role comparatively with that of TNF-alfa, regarding the decrease of the plasmatic level of albumin, and due to this, the primordial cause for hypoalbuminemia is an acute hepatic phase reaction. Supplemental permeability of the capillary wall under the action of TNF alpha has a secondary role, but could lead to a faster decrease in plasmatic albumin in the first hours after the surgical procedure.

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 Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

2009 ◽  
Vol 91 (3) ◽  
pp. 205-209 ◽  
Author(s):  
JO Larkin ◽  
TB Thekiso ◽  
R Waldron ◽  
K Barry ◽  
PW Eustace
Keyword(s):  
Emergency Surgery ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Sigmoid Volvulus ◽  
High Rate ◽  
Colonoscopic Decompression ◽  
Non Operative Management ◽  
Overall Mortality

INTRODUCTION Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

AOA ophthalmology and otolaryngology program closures as a model to highlight challenges of maintaining GME in high need areas

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Harris Ahmed ◽  
Kim Vo ◽  
Wayne Robbins
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Administrative Support ◽  
Surgical Care ◽  
Neck Surgery ◽  
Institutional Commitment ◽  
Surgical Specialty ◽  
Graduate Medical ◽  
Surgical Subspecialty ◽  
Hospital Administrative

Abstract Context While 90% of former American Osteopathic Association (AOA) residency programs transitioned to Accreditation Council for Graduate Medical Education (ACGME) accreditation, surgical subspecialty programs such as ear, nose, and throat (ENT, 62%) and ophthalmology (47%) struggled to gain accreditation. Doctors of Osteopathic Medicine (DOs) actively participate in serving underserved communities, and the loss of AOA surgical specialty programs may decrease access to surgical care in rural and nonmetropolitan areas. Objectives To determine the challenges faced by former AOA-accredited surgical subspecialty programs during the transition to ACGME accreditation, particularly ENT and ophthalmology programs in underresourced settings. Methods A directory of former AOA ENT and Ophthalmology programs was obtained from the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery (AOCOO-HNS). A secured survey was sent out to 16 eligible ENT and ophthalmology program directors (PDs). The survey contained both quantitative and qualitative aspects to help assess why these programs did not pursue or failed to receive ACGME accreditation. Results Twelve of 16 eligible programs responded, com-prising six ophthalmology and six ENT PDs. Among the respondents, 83% did not pursue accreditation (6 ophthalmology and 4 ENT programs), and 17% were unsuccessful in achieving accreditation despite pursuing accreditation (2 ENT programs). Across 12 respondents, 7 (58%) cited a lack of hospital/administrative support and 5 (42%) cited excessive costs and lack of faculty support as reasons for not pursuing or obtaining ACGME accreditation. Conclusions The survey results reflect financial issues associated with rural hospitals. A lack of hospital/administrative support and excessive costs to transition to the ACGME were key drivers in closures of AOA surgical specialty programs. In light of these results, we have four recommendations for various stakeholders, including PDs, Designated Institutional Officials, hospital Chief Medical Officers, and health policy experts. These recommendations include expanding Teaching Health Center Graduate Medical Education to surgical subspecialties, identifying and learning from surgical fields such as urology that fared well during the transition to ACGME, addressing the lack of institutional commitment and the prohibitive costs of maintaining ACGME-accredited subspecialty programs in underresourced settings, and reconsidering the Centers for Medicare & Medicaid Services (CMS) pool approach to physician reimbursement.

Introduction

2020 ◽  
pp. 1-10
Keyword(s):  
United Kingdom ◽  
Surgical Care ◽  
Second World War ◽  
British Association ◽  
Paediatric Surgery ◽  
World War ◽  
Surgical Specialty ◽  
The United Kingdom ◽  
Second World

Paediatric surgery is the surgical care of children from fetus to adolescent. It is a comparatively new surgical specialty, only formally recognized after the Second World War. This chapter provides a history and overview of the specialty, including the associations related to paediatric surgery, and biographies of famous surgeons who contributed to the field throughout their careers. The main organization in the United Kingdom is the British Association of Paediatric Surgeons (BAPS) founded in 1953 with Sir Denis Browne as the first president. Though based in London, it now has many international contacts and, through its conferences and symposia inside and outside the United Kingdom, is a leading educational provider in the specialty.

scholarly journals Surgical stress detection in human blood plasma by DSC

2020 ◽  
Vol 142 (2) ◽  
pp. 783-788 ◽  
Author(s):  
Andrea Ferencz ◽  
Dénes Lőrinczy
Keyword(s):  
Blood Loss ◽  
Blood Plasma ◽  
Surgical Intervention ◽  
Surgical Stress ◽  
Venous Blood ◽  
Operation Time ◽  
Major Surgery ◽  
Human Blood Plasma ◽  
Thermal Transitions ◽  
Surgical Interventions

Abstract It is a well-known fact that the extension of the surgical intervention influences both the success and time of the patient’s recovery, the degree of the blood loss, i.e., overall the patients’ surgical burden. Disease itself determines extent of surgical procedure (minor, intermediate or major surgery), which affects the risk and frequency of complications. Previous works have contributed to the validation of differential scanning calorimetry (DSC) as a potential non-invasive tool for diagnosing and monitoring several illnesses. Hence, the main goal of this study was to measure the effect of each surgical intervention on its own to blood plasma composition. Peripheral venous blood samples were collected from patients who underwent minor (n = 8), intermediate (n = 9) and major surgical interventions (n = 7). According our DSC data of blood plasma components, from the thermodynamic parameters, namely from the thermal transitions (Tm1–Tm8) to calorimetric enthalpy (ΔHcal) in proportion corresponded to the size of surgical interventions (duration of operation time, length of incision, surgical intraoperative stress, blood loss, etc.). This examination has shown that intraoperative stress during any surgical intervention affects the composition of plasma proteins, which should be always considered in the evaluation of DSC results in any surgical study.

scholarly journals Time for metrics in emergency surgical care – the role of an emergency surgery registry

2019 ◽  
Vol 51 (4) ◽  
pp. 306-315
Author(s):  
Randal Parlour ◽  
Alison Johnson ◽  
Paula Loughlin ◽  
Angus Watson ◽  
Michael Sugrue ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Surgical Care

scholarly journals Accessory extensor pollicis longus tendon in emergency surgery

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052093859
Author(s):  
Qing Jiang ◽  
Haiying Zhou ◽  
Kai Huang ◽  
Hui Lu
Keyword(s):  
Emergency Surgery ◽  
Surgical Outcomes ◽  
Surgical Procedure ◽  
Extensor Tendon ◽  
Tendon Sheath ◽  
Extensor Pollicis Longus ◽  
Case Presentation ◽  
Work Related ◽  
Work Related Injury ◽  
Extensor Pollicis Longus Tendon

Background A true accessory extensor tendon of the thumb seems to be rare. We found a variation of the accessory extensor pollicis longus (EPL) tendon while performing an emergency surgical procedure. Identification of this accessory tendon during emergency surgery has not been previously reported. Case presentation: A 43-year-old man presented to our hospital after sustaining a work-related injury involving a saw. During the operation, the tendons of the EPL, accessory EPL, and extensor pollicis brevis were severed. The lacerated tendon and tendon sheath were repaired, and the wrist and thumb were positioned in extension. The patient’s postoperative activity returned to normal without the need for a second tendon release operation. Conclusions Surgeons should be aware of this anatomic anomaly of the EPL tendon. Presentation of our case increases clinicians’ chances of preoperatively detecting this anomaly, which can improve surgical outcomes.

Evaluation of Thrombotic Events in Haemophiliacs Undergoing Major Orthopaedic Surgery without Thrombosis Prophylaxis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4072-4072
Author(s):  
Manuela Krause ◽  
Charis von Auer ◽  
Andreas Kurth ◽  
Martina Boehm ◽  
L. Hovy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Knee Replacement ◽  
Postoperative Period ◽  
The Body ◽  
Treatment Center ◽  
Major Surgery ◽  
Thrombosis Prophylaxis ◽  
Compression Stockings ◽  
Surgical Interventions ◽  
Apc Resistance

Abstract Introduction:Major orthopaedic procedures and the presence of thrombophilia are risk factors of thrombotic events. In patients with haemophilia undergoing hip or knee replacement the importance of thrombosis prophylaxis with heparin in the postoperative period is still unknown. The aim of the present study was to evaluate the occurence of thrombotic events in haemophiliacs undergoing major surgery without thrombosis prophylaxis. Patients: A total of 32 pts with haemophilia A (severe:27 pts, moderate:4 pts, mild:1pt; median age:47yrs, range:27–73yrs) undergoing hip (n=9)or knee (n=35) replacement were analysed in our haemophilia treatment center. Pts with inhibitors were excluded. Surgical interventions were performed using recombinant (n=37) or plasma-derived (n=7) FVIII for 12 to 15 postoperative days. The median initial dose of FVIII was 82 IU/Kg−1, followed by median FVIII doses of 54 IU/kg−1over the first four days. All pts received thrombosis prophylaxis with graduated compression stockings only. In addition to factor VIII activity, APC resistance, FV G1691A mutation and the FII G20210A variant (FII) were investigated. Results: No thrombotic events in the postoperative period was dokumented. The median FVIII activity was 153% (range:85–347%), the Body mass index (BMI:kg/m2) was 23.1(range:18.2–30.5). During the first four postoperative days FVIII levels >150% were measured in 24/44 (55%) operative procedures. BMI>25 were shown in 12/32 (38%) pts, and age >40yrs was documented in 23/32 (72%) pts. In 1/30 (3%) pt APC resistance and none of our pts FII were identified. Conclusion: In our study group elevated FVIII levels and additional risk factors (BMI>25, age>40years) seems not to influence relevantly the occurrence of thrombotic events in pts with haemophilia undergoing hip or knee replacement without thrombosis prophylaxis. Further studies are required to confirm whether a thrombosis prophylaxis with heparin is needed in haemophiliacs undergoing high risk surgery.

scholarly journals Intestinal Ostomies Created During Emergency Surgery Possess Unique Challenges

2020 ◽  
Author(s):  
Wibke Schulte ◽  
Ilhamiyya Aliyeva ◽  
Michael Knoop ◽  
Johann Pratschke
Keyword(s):  
Emergency Surgery ◽  
Online Survey ◽  
Elective Surgery ◽  
Surgical Care ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Complication Rates ◽  
Emergency Patients ◽  
Artificial Opening

Abstract Background: The surgical creation of an artificial opening of the bowel, called ostomy, can become necessary for very different causative diseases. A special subgroup are ostomies created during emergency surgery, which pose particular challenges to affected patients. This work is dedicated to their detailed characterization.Methods: A retrospective analysis of surgical ostomy creations at an acute care university hospital and an online survey for patients with an ostomy were performed and evaluated.Results: In our study, about one third of all ostomies were created during emergency surgery (37.4%). Compared to patients who received an ostomy during elective surgery, emergency patients had a higher ASA score and diagnoses requiring acute surgical care. Patients undergoing emergency surgery were more likely to have inadequate preoperative medical education (60% vs. 33.3%, p=0.029), and rarely received preoperative ostomy marking (4% vs. 79.2%, p<0.001). Emergency patients underwent minimally invasive surgery less frequently (26.8% vs. 51.3%, p=0.001), and showed a higher rate of peristomal wound dehiscence (9.9% vs. 2.5%, p=0.028). Accordingly, emergency ostomies often resulted in an overall reduction in postoperative quality of life.Conclusion: Ostomies are often created during emergency surgery under suboptimal perioperative conditions. This results in higher complication rates and negative physical and psychological effects. Therefore, intensive interdisciplinary care is essential to provide the best possible care for patients affected by these artificially created intestinal outlets.

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