Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
earthquake struck the Pazarcık district of Kahramanmaras, Türkiye at 04:17 A.M. local time, followed by another magnitude of 7.6 (Mw) earthquake in the Elbistan district of Kahramanmaras at 01:24 P.M. local time on the same day. A large area in Türkiye and Syria was affected by these successive earthquakes. Hundreds of thousands of individuals were injured and thousands lost their lives due to collapsed buildings. As a result of the destructive impact of the earthquake, millions of individuals were forced to migrate.The injury patterns of those trapped under the rubble vary widely, ranging from severe organ injuries that lead to sudden death to non-fatal minor skin abrasions. While musculoskeletal injuriesObjectives: This study aims to investigate the types of wounds and wound care in earthquake victims rescued from collapsed buildings after the 2023 Kahramanmaras earthquake. Patients and methods: Between February 8 th , 2023 and March 1 st , 2023, a total of 94 patients (46 males, 48 females; mean age: 40.2±15.5 years; range, 16 to 77 years) with earthquake-related wounds who were trapped under rubble were retrospectively analyzed. Data including age, sex, duration of being trapped under rubble, type and location of the wound, bacterial cultures from deep tissue, and wound care methods used were recorded. Results:The mean duration of being trapped under rubble was 58±38.1 h. Wounds were most commonly located on the lower extremities, followed by the upper extremities. The most common type of wounds were abrasions, followed by necrotic wounds due to crushing. Wound and skin antiseptics, debridement and negative pressure wound therapy (NPWT) were the most common wound care methods used. Conclusion: Various types of injuries and wounds may occur after natural disasters. Chronic wound care is as important as the management of life-threatening acute pathologies. Preparations should be made properly for the long-term treatment of patients after disasters. Methods such as NPWT, debridement creams containing collagenase, wound and skin antiseptics, and hyperbaric oxygen therapy can provide satisfactory short-term results. A broader and more intense application of these treatments is thought to be beneficial, particularly in crush injuries.
Background Sudden change in general surgery practice during pandemic caused a detrimental effect on residency training. The main objective of this study is to reveal the effect of Covid-19 pandemic on general surgery practice and surgical residency education. Methods This retrospective cross sectional study included all patients operated at a tertiary university hospital, general surgery department between 11-March 2019/ 11- January-2019 (Pre-Covid 19 Period) and 11-march 2020- 11- January − 2020 (Covid 19 period). Two period compared in terms of case volume, complexity difference and effect of this difference on residents training. Results Overall 2740 cases included to study. Elective case volume significantly decreased during pandemic (p = 0.001). This decrease is much more obvious for B-C category operations. Intermediate seniority resident’s case volumes and complexity of the cases they performed decreased during pandemic. Conclusion Surgical residency programs must be revised urgently in order to provide adequte training which altered due to Covid-19 pandemic.
Background: Several studies on the reduction of pain with the use of local anesthetics after laparoscopic hernia surgeries have been published. We aimed to analyze the results of local anesthesia applied to the patients by retrospectively scanning the files of patients who underwent total extraperitoneal laparoscopic hernioplasty for inguinal hernias. Methods: The files of patients who underwent TEP laparoscopic hernioplasty for inguinal hernias between March 2019 and November 2022 in Ankara Bilkent city hospital general surgery clinic were retrospectively scanned. The pain scoring records in the observation forms of these patients and the analgesics administered were recorded. Results: A total of 374 and 210 patients underwent unilateral and bilateral TEP laparoscopic hernioplasty, respectively. All of the patients, 232 were not administered any local anesthesia, 186 were administered bupivacaine, and 166 were administered bupivacaine+dexamethasone. When the VAS scores of the patients in both main groups were compared, significant differences were found in VAS scores between patients who received bupivacaine and bupivacaine+dexamethasone and those who did not (p<0.036 and p<0.025). No difference was found between patients who received only bupivacaine and those who were given bupivacaine+dexamethasone. Conclusion: In patients who underwent TEP laparoscopic hernioplasty, spraying bupivacaine into the preperitoneal area after surgery was found to be significantly effective in reducing postoperative pain. The benefits of adding dexamethasone to bupivacaine have not been established.
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