To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Background Many urgent and elective surgeries were postponed to cope with the Coronavirus disease (COVID-19) pandemic, with latest data found a substantial postoperative mortality risk (25·6%, 18.9%) after emergency and elective surgery, respectively. Our institution was one of the first trust to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic. The aim of this study is to analyse the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK. Method Retrospective analysis of outcomes all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway”. The primary endpoints were 30 days mortality and COVID related morbidities, and the secondary endpoints were surgical related complications and oncological outcomes. Results 92 patients (Male:45%; Female:55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications. Conclusions It is possible to mitigate the high mortality risk of postoperative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.
Via the hospital's electronic clinical database, we were able to identify all >45 years old patients who underwent an emergency appendicectomy. Imaging data was obtained, with histologically-confirmed appendicitis cases comprising the bulk of the study. An initial audit e encompassing the period from January 2007 to December 2016 e was undertaken in April 2019. Our findings cited two cardinal recommendations, namely: that a CT abdomen be performed in all patients over the age of 45 e with a histopathologically-confirmed appendicitis e prior to their appendicectomy, and that a colonoscopy be performed on all patients in the aforementioned group, within 1 year, post-operatively. Adherence to our proposal was audited from October 2019 e February 2020. Results: Of the 57 patients who underwent a post-operative colonoscopy e median follow-up 4 months e only 22.8% were for post-appendicectomy examination. 4 patients were found to have proximal colonic polyps, whilst 1 patient was found to have ascending colon cancer e identified 5 months post-appendicectomy. The reaudit conveyed e of the 62 patients >45 years old, who had appendicectomies e 83.3% underwent a pre-operative CT. Indeed, 63.7% had colonoscopies scheduled at 6 weeks, post-operatively, however, only 18.2% had the procedure e all of which were normal. Conclusion:The findings from our rural DGH can help guide more apt bowel cancer care, pertaining to peri-operative imaging and endoscopic investigations. Whilst imaging recommendations were adhered to well, post-operative colonoscopies were not.
BackgroundThe coronavirus disease (COVID-19) had so far claimed more than 600 000 lives worldwide. Many urgent and elective surgeries were postponed to cope with the pandemic, with the latest data found a substantial postoperative mortality risk (25.6%, 18.9%) after an emergency and elective surgery, respectively. Our institution was one of the first few in the country to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic. This study aims to analyze the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK. MethodsRetrospective analysis of outcomes of all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway.”The primary endpoints were 30 days mortality and COVID-related morbidities, and the secondary end-points were surgically related complications and oncological outcomes. ResultsA total of 92 patients (Male: 45%; Female: 55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications. There were 7 postoperative surgical complications managed at the acute hospital site. The waiting time for surgery ranges from 6 to 191 days, mean of 30 days, and a median of 23 days. ConclusionIt is possible to mitigate the high mortality risk of post-operative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.
Introduction Patients with blunt chest wall injuries often have severe associated injuries and even isolated chest injuries may have a high mortality and morbidity. The National Audit Office (2010) report estimated that there are 20,000 cases of major trauma per year in England; 5,400 people die of their injuries with many others sustaining permanent disability. Aim To assess compliance with trust guidelines for chest trauma pathway and the impact of poorly controlled pain on hospital acquired pneumonia (HAP) rate and hospital admission length Method A retrospective audit of all chest trauma between October 2019 to February 2020. Data obtained from electronic patient records and admission notes. Patients notes and imaging records are used to analyse adequate pain control based on local chest trauma pathways. Results 28 patients identified (M:F 15:13) aged 47-94 yrs old (average age 73) who suffered from chest trauma in a district general hospital in England. Chest trauma was associated with high levels of morbidity (32%) and mortality (7%). 39% of patients were found to have inadequate pain control based on the local chest trauma pathway. 33% of chest trauma patients developed a HAP and 44% of pts with inadequate pain control developed a HAP. The admission length of patients with HAP secondary to chest trauma was on average three times longer relative to uncomplicated patients (15 days vs 5 days). Conclusions Chest trauma patients often receive inadequate pain control and delayed specialist team input. This results in an increase in the frequency of HAPs and admission length.
Aims/Background Prophylaxis at discharge is important in mitigating venous thromboembolism events from colorectal cancer and major abdominopelvic surgery, both of which are risk factors for venous thromboembolism. Foundation doctors frequently rotate between departments, and so rely on departmental induction and/or handing down of knowledge to prescribe extended venous thromboembolism prophylaxis upon discharge. Methods A retrospective audit of all patients who underwent surgery for colorectal cancer at The County Hospital, Hereford, between 1 August 2018 and 31 August 2019, was undertaken to assess departmental compliance with guidance from the National Institute for Health and Care Excellence. Results A total of 181 patients underwent elective surgery and 29 patients had emergency surgery. The initial audit revealed a cyclical 4-monthly decline that coincided with foundation doctors' rotations. Six multidisciplinary interventions were implemented. Reaudit demonstrated 100% compliance with prescribing of extended venous thromboembolism prophylaxis at discharge. No venous thromboembolism events 30 days post operation were noted. Conclusions A multidisciplinary approach involving educating health professionals about the importance of extended venous thromboembolis prophylaxis in patients who have undergone surgery for colorectal cancer can be effective in improving compliance with prescribing practices at discharge.
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