Evaluation of emergency operations and anesthesia procedures used in surgical emergencies before and during the COVID-19 pandemic

Abstract

BACKGROUND:The number of people actively participating in society has decreased following the coronavirus disease 2019 (COVID-19) pandemic as a result of the measures taken to reduce the risk of transmission, such as interruption to education, social isolation, and curfews. Accordingly, change in the etiology of emergency surgery and characteristics of patients may be expected. The current study aimed to compare emergency surgery between the COVID-19 pre-pandemic and pandemic periods and to present the data and emergency anesthesia management of patients with suspected COVID-19. METHODS:Patients who underwent emergency surgery in our hospital between January 22 and April 29, 2020, were examined retrospectively. The patients were divided into two groups: Those operated before March 11, 2020 (Group 1) and those operated from this date April 29, 2020 (Group 2). The data of the two groups were compared. Routine emergency anesthesia and surgical approach were applied to all patients in Group 1 and those without suspected COVID-19 in Group 2. Patients with suspected COVID-19 in Group 2 were treated with an algorithm created in accordance with the guidelines of official institutions and scientific associations. RESULTS:Age, gender, chronic medical diseases, ASA classification, Mallampati score, surgical department, surgical procedures, surgical etiology, duration of surgery, and length of hospital stay were similar in both groups. The number of patients undergoing general anesthesia and spinal anesthesia was 198 (82.5%) and 42 (17.5%) for Group 1 while it was 161 (73.9%) and 57 (26.1%), respectively, for Group 2 (p=0.025). CONCLUSION:The clinical data and surgical features of emergency patients during the pandemic were similar to those before the pandemic; however, the rate of spinal anesthesia was higher in the former. Personal protective equipment standards should be followed to prevent cross-infection among the anesthesiology team during anesthesia procedures for emergency operations. We consider that necessary emergency interventions can be safely performed and COVID-19 nosocomial infection can be prevented in the operating room by following the Ministry of Health recommendations and guidelines that are updated regularly.

Comparison of demographic and clinical characteristics between pandemic and pre-pandemic period in non-COVID intensive care units: a retrospective study

“…[ 11 ] Furthermore, Schöni et al, reported that surgical interventions decreased during the pandemic period. [ 12 ] Unlike the literature, in our study, the number of post-operative patients admitted to ICU was higher during the pandemic period. We think, the reason is that anesthesiology and reanimation ICU was the only non-COVID ICU for post-operative patients in our hospital and emergency and oncological surgeries were continued during the pandemic period.…”

Evaluation of Emergency Operations and Anesthesia Preferences in the Early COVID-19 Pandemic and Before the Pandemic: A Retrospective Cross-Sectional Study

“…Uludağ Yanaral ve ark., pandemi dönemindeki acil cerrahileri inceledikleri çalışmalarında, en fazla uygulanan operasyonu %52 ile sezaryen olarak bildirmişlerdir. 11 Çalışmamızda da benzer şekilde, en fazla uygulanan cerrahi operasyon %62,7 ile sezar- Tankel ve ark., pandemi döneminde akut apandisit başvurularının %40 oranında azaldığını belirterek, hafif apandisitli hastaların evde semptomatik tedavi ile iyileştiği sonucuna varmışlardır. 12 Gallego ve ark.nın çalışmasında da pandemi sırasında genel cerrahi acil müdahale sayısının günde ortalama 3,6'dan 1,6'ya düştüğü, 20 günlük dönemde sadece 4 apendektomi yapıldığı ve tüm olguların komplike apandisit olduğu bildirilmiştir.…”

“…21 Başka bir çalışmada da pandemi döneminde hastaların %26'sında spinal anestezi tercih edildiği, pandemi öncesi döneme göre spinal anestezi uygulanan hasta sayısının anlamlı olarak yüksek olduğu bildirilmiştir. 11 Çalışmamızda, pandemi öncesi dönemde operasyonların %7,4'ünde spi-nal anestezi uygulanırken, pandemi dönemindeki operasyonların %48,3'ü spinal anestezi altında gerçekleştirilmiştir (p<0,001). Cerrahi bölümler ve anesteziyoloji ekiplerinin COVID-19 için yayımlanan kılavuzlara dikkat etmelerinin, spinal anestezi oranlarının artmasında etkili olduğunu düşünüyoruz.…”

“…Uludağ Yanaral ve ark., hastaların ortalama 3,7 gün hastanede kaldığını, kalış süresinin anlamlı olmasa da arttığını belirtmişlerdir. 11 Çantay ve ark. ise 5 gün ve üzeri hastanede kalan hasta sayısının anlamlı olarak azaldığını belirtmişlerdir.…”