Introduction Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. Methods A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. Results A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = \ 0.05) as did severity (0 per cent [ grade 1 vs 58.3 per cent [ grade 1, p = \ 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = \ 0.05) as did the mean operating time (102.4 vs 145.7 min, p = \ 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. Conclusion Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.
Perianal actinomycosis infection is a very rare occurrence and is challenging to diagnose. Nicorandil is a potassium channel agonist, which is used in the treatment of ischaemic heart disease. Its usage is associated with perianal ulceration and delayed surgical wound healing. We report a case of actinomycosis complicating a chronic perianal ulcer, which was associated with long-term nicorandil usage. It raised the suspicion of malignancy and required over six months of antimicrobial treatment to achieve satisfactory healing. Perianal actinomycosis results in chronic infection which spreads across tissue planes and can resemble an ulcerated malignancy. Nicorandil usage can result in perianal ulceration and produces conditions which are conducive to actinomycosis infection. In such cases, nicorandil therapy should be discontinued, if possible, and long-term systemic antibiotics form the mainstay of treatment.
Introduction Covid-19 has had a significant impact on all aspects of healthcare. Efforts to maintain oncological surgery have continued throughout the pandemic despite facing significant challenges. We aimed to characterise our experience of oncological surgery during the first 2-months of the pandemic in Scotland and compare that with the same period in 2019. Methods A prospective cohort study was performed from 23/03/20 to 07/05/20. All elective oncological operations at a single district general hospital, predominantly managing breast and colorectal malignancies, were included. Data on patient demographics, waiting time to surgery, inpatient characteristics and oncological outcomes were recorded. Statistical analysis was used to compare these with retrospective data from 2019. Results A total of 37 patients were included, 18 in 2019 and 19 in 2020. There were no differences in patient age (63 vs 66.2 years, p = 0.486), length of stay (5.3 vs 4.3 days, p = 0.697) time spent on waiting list (25.4 vs 20.9 days, p = 0.303) or surgical approach (p = 0.300). Oncological outcomes were comparable with no statistical difference in clear resection margin status (88.9 vs 84.2%, p = 0.189) or positive nodal status (5.6 vs 26.3%, p = 0.086). No patient in either cohort had a post-operative complication. Conclusion Oncological surgery during Covid-19 can be performed safely and with favourable oncological outcomes. The longer-term effects from delayed diagnoses remain to be evaluated.
Introduction Covid-19 has had a significant impact on all aspects of healthcare. We aimed to characterise our experience of oncological general surgery during the first 4-months of the pandemic and compare with the same period in 2019. Method A prospective cohort study was performed from 23/03/20 to 08/07/20. All elective oncological operations were included. Data on patient demographics, waiting times, inpatient characteristics and oncological outcomes were recorded. Statistical analysis was used to compare with retrospective data from 2019. Results 78 patients were included in total, 38 in 2019 and 40 in 2020. There were no differences in length of stay (2.5 vs 3.5 days, p = 0.355) or waiting list time (27.2 vs 24.2 days, p = 0.574). Oncological outcomes were comparable with no statistical difference in clear resection margin status (94.4 vs 84.6%, p = 0.168) or positive nodal status (24.1 vs 37.1%, p = 0.298). The percentage of staging CT scans requested externally was higher in 2020 (4 vs 32%, p = <0.05). There was no difference in time from urgent referral to first assessment (30.5 vs 26.4 days, p = 0.384) or time to operation (96.6 vs 85.7 days, p = 0.618). Conclusions Oncological surgery during Covid-19 can be performed safely with favourable oncological outcomes. The longer-term effects from delayed diagnoses remain to be evaluated.
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