Background and aim COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. Methods Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. Results One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. Conclusion CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.
We achieved favorable results with a 2-stage reconstruction technique and suggest that the paucity of evidence related to single-stage procedures does not support a change in surgical management.
Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information
Aim Surgical patients are often placed within non-surgical wards due to shortage of beds, however the care of these patients remains under the parent surgical team. Unfortunately, patients outwith surgical areas can frequently feel neglected, with staff often unsure who to contact for reviews. This project aims to improve communication between boarding wards and the surgical team, as well as improving patient care and management. Method This prospective study was based on the Model for Improvement Framework approach to quality improvement. Data was gathered using questionnaires from various staff members on non-surgical wards. Outcomes were measured on a qualitative basis. Results Qualitative data was collected from 45 nursing staff (NS). Prior to introduction of a designated boarder’s bleep, 25% of NS felt they knew who to contact for queries and reviews, whereas 46% contacted the parent ward and 29% contacted the on-call surgical registrar. Only 46% of boarded patients received daily reviews. Following introduction of a dedicated surgical registrar for boarders, 62% of NS felt they knew who to contact with 48% aware of surgical boarder’s bleep. Daily reviews of patients increased to 65% over the course of the cycles of this project. Conclusions Bed shortages can play a vast role in patient care and treatment. This study has effectively demonstrated an improvement in provision of patient care, demonstrating an increase in NS knowing who to contact, as well as a 19% increase in daily patient reviews. Introduction of a dedicated boarder’s bleep-holder has shown improvement in clinical communication and management.
Introduction Acute aortic dissection type A (AADA), a tear in the intima lining of the aorta, is a surgical emergency and contributes to high mortality rate if not managed promptly with surgical intervention. Case presentation We describe a case of a 63-year-old female with a history of hypertension presented with presumed seizure and hypotension to the emergency department. She did not have Computed Tomography (CT) chest despite having hemopericardium on her CT abdomen and pelvis. Her condition deteriorated to pericardial effusion, cardiac tamponade, multi-organ failure and shock. A diagnosis of AADA was only found on the stage of post-mortem. Conclusion AADA may not present with classical symptoms of tearing chest pain. The combination of hypotension and neurological deficit should trigger hospital team to consider aortic dissection higher up in the differential diagnosis for shock. If there is unclear diagnosis for an acutely unwell patient, hospital team should review the case and radiological imaging again. Hemopericardium on CT abdomen, pelvis should trigger hospital team to request for a CT chest to look out for the cause of hemopericardium. AADA is fatal without prompt surgical intervention. Immediate diagnosis can significantly reduce the mortality rate.
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