Background Coronavirus disease 2019 (COVID‐19) impacted Hong Kong in early January 2020. Quarantine and social distancing measures have been implemented to prevent disease spread. Material and Method Retrospective cohort study was carried out in our cluster to compare the acute appendicitis cases during pandemic period, January 1, 2020 to June 30, 2020, with the same period 1 year before. Parameters including time of presentation, complicated appendicitis rate, operative time, post‐operative complication rate, and total length of stay were compared and analysed. Results A total number of 348 patients (160 in the pre‐COVID group versus 188 in the post‐COVID group) were included. There is no significant difference in basic demographics. The time of presentation was significantly longer in March (3.75 days vs 1.56 days, P = .031) and June 2020 (3.02 days vs 1.88 days, P = .026) compared with the pre‐COVID group, which correlate with the spike of local confirmed cases. There was a significantly higher incidence of complicated appendicitis (67% vs 52%, P = .028) and post‐operative complication rate (29% vs 7%, P = .042) in February post‐COVID group compare with the pre‐COVID group. Conclusion During the COVID‐19 pandemic period, more patients with acute appendicitis presented late to the hospital, with an increase in complicated appendicitis rate and post‐operative complication rate.
Aim The aim of the present study was to identify the significant risk factors predicting the occurrence of postoperative pneumonia after major or ultra‐major operations (OT), and construct a predictive score to identify high‐risk patients for postoperative pneumonia. Patients and Methods A total of 6237 patients who underwent major/ultra‐major operations in a single institute were recruited to participate in the present study. Data from 1742 patients who underwent major or ultra‐major operations from July 2012 to June 2013 were retrieved from the Surgical Outcome Monitoring and Improvement Program database. Thirty‐eight variables were analysed by univariable analysis method. Significant factors with a P‐value ≤0.05 were further analysed by using the multivariable logistic regression model. A scoring system was then formulated by using these significant risk factors to identify high‐risk patients. The efficacy of this scoring system was examined by applying this to another 4495 patients. Results Thirty‐eight variables were included in this study (7 patients’ demographic variables, 20 preoperative and 11 operative or disease‐related variables). Five of 38 variables were found to be significant, including (i) Dependence of activity of daily living; (ii) Ascites; (iii) General anaesthesia; (iv) preoperative Dyspnoea; and (v) American Society of Anaesthesiology (ASA ) score ≥3. They formed the basis of the DAGDA score. The maximum DAGDA score was 18, with an area under the ROC curve score of 0.774 (95 per cent confidence interval: 0.711–0.836). The sensitivity and specificity of the DAGDA score with a cut‐off point of 8 were 73.6 and 73.4 per cent, respectively. Validation of the DAGDA score was examined by using another cohort group of 1329 patients (July 2010–June 2011 database), with an area under the ROC curve score of 0.751. Similar results were achieved when the scoring system was applied to the July 2013–June 2014 (1671 patients) and July 2014–June 2015 (1495 patients) database. Conclusion Dependence of activity of daily living, ascites, general anaesthesia, preoperative dyspnoea and ASA score ≥3 are significant risk factors associated with postoperative pneumonia after major and ultra‐major operations. The DAGDA score can be used to predict patients at high risk of developing postoperative pneumonia.
Aim: The reported incidence of postoesophagectomy chylothorax is 1.2-4 per cent. The diagnosis is based on clinical suspicion: milky chest drain fluid and/or high volume chest drain output. Confirmatory tests involve sending fluid for laboratory investigations. Chylothorax is a potentially lethal condition and carries a high morbidity rate. An early diagnosis can potentially help to identify those who might require operation, dietary restrictions or other treatments. The aim of the present study was to evaluate chylothorax in postoesophagectomy patients. Patients and Methods: We extracted data from patients who underwent oesophagectomy at Tuen Mun Hospital from 2004 to 2018 for the present retrospective study. Chest drain fluid from every patient was sent every postoperative day for testing for chyle, regardless of quantity and whether or not it was milky. The characteristics of the patients, disease, operations, perioperative conditions, postoperative complications, hospital stay, interventions, morbidity and mortality and chest drain outputs were compared. Results: The incidence of chylothorax in our cohort was 9 per cent (14/155). There were nine biochemical chyle leaks (64.3 per cent) and five clinical leaks (35.7 per cent). The biochemical leakage group had a significantly higher 1-month morbidity rate compared to the nonchylothorax patients (89.9 vs 50 per cent, P = 0.03). All biochemical leaks were resolved with conservative management. The entire chylothorax group also had a longer hospital stay (25.5 vs 17 days, P = 0.04) compared to the nonchylothorax group. Thoracotomy was done in two patients with clinical leaks, and the remaining leaks were resolved with conservative management. In subgroup analysis, the biochemical leak subgroup was found to have a higher 1-month morbidity rate (88.9 versus 50 per cent, P = 0.03) compared to the nonchylothorax group. Conclusion: By routinely screening for chylothorax, the incidence was found to be 9 per cent, higher than that reported in the literature. The biochemical leak subgroup was found to have a higher 1-month morbidity rate. This could suggest that biochemical leakage of chyle might have a clinical impact on the recovery of postoesophagectomy patients.
Endoscopic ultrasound is an accurate method and its demand is increasing. The performance in a community hospital can be further improved and its utilization should expand to other indications.
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