The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. Background: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. Methods: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. Results: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July. Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM. The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing. Conclusion:The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status. Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.
The baby was born full term via spontaneous vaginal delivery to non-consanguineous parents (Table 1). He was breastfed every 3-4 h. At 57 h-of-life, he missed a feed stretching to a 6-h feeding interval. He was then noted to be hypothermic, pale and lethargic with a weak cry. He was also hypotonic and had hepatomegaly. He was transferred to the special care nursery. Investigations showed hypoglycaemia (1.5 mmol/L) and transaminitis (Table 1). He was treated with a 10% dextrose bolus (2 mL/kg) and maintained on Solution 120 (dextrose containing fluids) at 120 mL/kg/day. Within 24 h, the patient's lethargy, hypothermia and hypoglycaemia resolved but abnormal transaminases persisted. The metabolic service was consulted on day 4 of life and the differential diagnosis included fatty-acid oxidation and glycogen storage disorders. The patient was transferred to the tertiary hospital for management. Septic work-up was negative. The laboratory findings of rhabdomyolysis and transaminitis especially AST which is present in high concentrations in skeletal muscles were more in keeping with a fattyacid oxidation disorder. The abnormal acylcarnitine species (particularly C14:1 and its ratio to C10) in the dried blood spot, increased C4:1 species on qualitative analysis of the plasma carnitine and results of the genetic and enzymatic tests supported the diagnosis of VLCAD deficiency (Table 1). With low long-chain fat diet supplemented with medium-chain fats, the creatine kinase gradually decreased. Our patient had a severe and early clinical presentation with significant hypoglycaemia and rhabdomyolysis with no cardiac involvement. Management of the patient included a low long-chain fat diet supplemented with medium-chain fats and avoidance of prolonged fasting or dehydration to prevent complications such as hypoglycaemia and rhabdomyolysis. 2 When the patient is unwell, especially with poor oral intake, the parents have been advised to call the metabolic service and present early to an emergency department for prompt assessment and intravenous glucose therapy. This case highlights that: (i) a fatty acid oxidation disorder should be suspected in newborns/infants with unexplained hypoglycaemia and/or acute liver disease, rhabdomyolysis and cardiac arrhythmias/ cardiomyopathy; (ii) glucose-containing fluids should be started; (iii) newborns with a fatty-acid oxidation disorder can become symptomatic even before newborn bloodspot screening can be done; and (iv) Prompt referral to a metabolic service is recommended.
Background In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. Methods PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11–3-2020 to 13–9-2020. Results A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. Conclusion The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.