Safe Elective Surgical Practice During COVID-19 Pandemic – A Prospective Observational Study of 303 Elective Surgeries in the UK

ObjectivesTo understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.DesignA prospective observational study.Setting3 large acute medical receiving units in NHS Lothian, Scotland.ParticipantsNon-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954).Main outcome measuresPatient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.ResultsNon-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001).ConclusionsThese data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.

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What Are the Trends in Tonsillectomy Techniques in Wales? A Prospective Observational Study of 19,195 Tonsillectomies over a 10-Year Period

International Journal of Otolaryngology ◽

10.1155/2015/747403 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hussein Walijee ◽

Ali Al-Hussaini ◽

Andrew Harris ◽

David Owens

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Surgical Instrument ◽

Bipolar Diathermy ◽

Intraoperative Bleeding ◽

Surveillance Programme ◽

National Guidance ◽

Secondary Haemorrhage ◽

The Uk ◽

Cold Steel Dissection

There are a multitude of techniques to undertake tonsillectomy, with hot techniques such as diathermy and coblation being associated with a higher risk of secondary haemorrhage. The UK National Prospective Tonsillectomy Audit (2004) advocated cold steel dissection and ties to be the gold standard. This prospective observational study investigates the trends in tonsillectomy techniques across Wales in the last decade to establish if surgeons have adhered to this national guidance. Data relating to tonsillectomy were extracted over a 10-year period from 1 January 2003 to 31 December 2012 from the Wales Surgical Instrument Surveillance Programme database. A total of 19,195 patients were included. Time-series analysis using linear regression showed there was an increase in the number of bipolar diathermy tonsillectomies by 84% (Pearson’sr=0.762,p=0.010) and coblation tonsillectomies by 120% (r=0.825,p=0.003). In contrast, there was a fall in the number of cold steel dissection tonsillectomies with ties by 60% (r=-0.939,p<0.001). This observational study suggests that the use of bipolar and coblation techniques for tonsillectomy has increased. This deviation from national guidance may be due to these techniques being faster with less intraoperative bleeding. Further study for the underlying reasons for the increase in these techniques is warranted.

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1498 A Ten-Year Observational Study of The Use of Two-Way Catheters Post-Transurethral Resection of The Prostate Without the Use of Post-Op Irrigation

British Journal of Surgery ◽

10.1093/bjs/znab259.1112 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Kretzmer ◽

A Damola ◽

M Sandher ◽

W Martin ◽

S. Ali Ehsanullah ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Primary Outcome ◽

Average Duration ◽

Bladder Irrigation ◽

Post Operative Period ◽

Operative Care ◽

Nice Guidance ◽

Secondary Outcomes ◽

The Uk

Abstract Over 15,000 transurethral resections of the prostate (TURP) are performed yearly in the UK. It is therefore vital that peri-operative care is optimised. Our centre favours the use of two-way catheters post-operatively without continuous bladder irrigation (CBI). Aim To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared to standard three-way catheterization. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed. Method This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Prospective patient data were collected pertaining to peri-operative factors. This data was then compared with data published in the NICE guidance pertaining to TURP. Results 687 patients underwent TURP at our centre between 2009-2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days. TWOC was successful in 93.74% (n = 644). Complication rate was 8.73% (n = 60), reduced in comparison to other units. Furthermore, when compared to other centres, our method reduced lengths of admission and transfusion rates (1.6 days vs. 3.1 days and 0.87% vs. 2.83% respectively). Conclusions Our method preserves patient safety and is associated with reduced length of admission. It also has cost-saving benefits and a reduced post-operative period of catheterisation. We recommend this practice to the wider urological community.

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