Lessons Learned During the COVID-19 Virus Pandemic

Sterpetti, Antonio V.

doi:10.1016/j.jamcollsurg.2020.03.018

Cited by 51 publications

(46 citation statements)

References 7 publications

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“…Taken together, postponing elective surgeries is not only a reasonable strategy, it seems to be the only rational path for neurosurgeons until the end of the pandemic [3,15]. The data from our US respondents indicated that even within the short 2 weeks of the principal study, the date of the response was a positive predictor of both the hospitals' response and neurosurgeons' opinion towards more stringent shutdown.…”

Section: Reasons Behind the Impact Of Covid-19 On Neurosurgerymentioning

confidence: 86%

“…As the novel coronavirus (SARS-COV-2) swept across the globe, the COVID-19 pandemic has disrupted all aspects of society, with a breadth and intensity unfathomable for those born after the last World War. With relatively few neurological manifestations [1][2][3], neurosurgeons have been sheltered from "frontline action" that is battering subspecialists in emergency, intensive care and pulmonary medicine, but nevertheless, the practice of neurosurgery is yet susceptible to the havoc that COVID-19 has wrought. On a systems level, teams of neurosurgeons have been re-deployed as intensivists, neurosurgical patients have been re-housed in COVID-clean wards, protocols have been implemented to test patients ahead of neurosurgical procedures, and hospital systems have been reorganized to "hub-and-spoke" configurations to segregate neurosurgery to designated centers [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study

et al. 2020

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Object The COVID-19 pandemic has disrupted all aspects of society globally. As healthcare resources had to be preserved for infected patients, and the risk of in-hospital procedures escalated for uninfected patients and staff, neurosurgeons around the world have had to postpone non-emergent procedures. Under these unprecedented conditions, the decision to defer cases became increasingly difficult as COVID-19 cases skyrocketed. Methods Data was collected by self-reporting surveys during two discrete periods: the principal survey accrued responses during 2 weeks at the peak of the global pandemic, and the supplemental survey accrued responses after that to detect changes in opinions and circumstances. Nine hypothetical surgical scenarios were used to query neurosurgeons' opinion on the risk of postponement and the urgency to re-schedule the procedures. An acuity index was generated for each scenario, and this was used to rank the nine cases. Results There were 494 respondents to the principal survey from 60 countries. 258 (52.5%) reported that all elective cases and clinics have been shut down by their main hospital. A total of 226 respondents (46.1%) reported that their operative volume had dropped more than 50%. For the countries most affected by COVID-19, this proportion was 54.7%. There was a high degree of agreement among our respondents that fast-evolving neuro-oncological cases are non-emergent cases that nonetheless have the highest risk in postponement, and selected vascular cases may have high acuity as well. Conclusion We report on the impact of COVID-19 on neurosurgeons around the world. From their ranking of the nine case scenarios, we deduced a strategic scheme that can serve as a guideline to triage non-emergent neurosurgical procedures during the pandemic. With it, hopefully, neurosurgeons can continue to serve their patients without endangering them either neurologically or risking their exposure to the deadly virus.

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Section: Reasons Behind the Impact Of Covid-19 On Neurosurgerymentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study

et al. 2020

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“…The risk of COVID-19-related mortality after esophagectomy was derived from reports of hospitalized or institutionalized patients with any type of cancer or other significant comorbidities, which contributed to a more virulent infection and higher acuity disease [ 4 , 31 , 33 , 34 ]. We felt these estimates appropriately reflected risk in esophageal patients because of their cancer diagnosis and high prevalence of post-operative pulmonary [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19

et al. 2020

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Background Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. We sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma. Methods A decision analysis model was developed, and sensitivity analyses performed. The base case was a 65-year-old male smoker presenting with cT1b esophageal adenocarcinoma scheduled for esophagectomy during the COVID-19 pandemic. We compared immediate surgical resection to delayed resection after 3 months. The likelihood of key outcomes was derived from the literature where available. The outcome was 5-year overall survival. Results Proceeding with immediate esophagectomy for the base case scenario resulted in slightly improved 5-year overall survival when compared to delaying surgery by 3 months (5-year overall survival 0.74 for immediate and 0.73 for delayed resection). In sensitivity analyses, a delayed approach became preferred when the probability of perioperative COVID-19 infection increased above 7%. Conclusions Immediate resection of early esophageal cancer during the COVID-19 pandemic did not decrease 5-year survival when compared to resection after 3 months for the base case scenario. However, as the risk of perioperative COVID-19 infection increases above 7%, a delayed approach has improved 5-year survival. This balance should be frequently re-examined by surgeons as infection risk changes in each hospital and community throughout the COVID-19 pandemic.

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“…The mortality rate increased from 14% in patients with only 1 comorbidity to 61% in patients with 3 or more comorbidities 1 . In the elderly population, the simultaneous occurrence of the COVID-19 infection and the presence of diffuse atherosclerotic disease were of course a common clinical scenario, specifically in the Lombardy region, where the outbreak was severe and overwhelming and a high proportion of the population is elderly 2 , 3 . Since the end of May, there has been a steady and marked decrease in rates of infection and mortality in Pavia and Italy as a whole.…”

Section: Introductionmentioning

confidence: 99%

Acute arterial and deep venous thromboembolism in COVID-19 patients: Risk factors and personalized therapy

Bozzani

Arici

Tavazzi

et al. 2020

Surgery

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Introduction The Lombardy region (Italy) suffered severe problems during the acute phase of the outbreak of COVID-19 in Italy (March-April 2020) with 16,000 diagnosed COVID-19 related deaths (49% of the total COVID-19 related deaths in Italy). In the area surrounding Pavia during the critical stage of the outbreak (March-April), 1,225 of the documented 4,200 deaths were related to COVID-19 infection, with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% compared to the same period in previous years. Aim Our aim was to report the experience of the Department of Vascular Surgery of Pavia (Lombardy), including the lessons learned and future perspectives regarding the management of COVID-19 patients who developed severe acute ischemia with impending lower limb loss or deep vein thrombosis (DVT). Materials and Methods We carried out a retrospective data collection of COVID-19 patients with severe acute ischemia of the lower limbs or DVT observed in our Department during the period March 1 st to April 30 th 2020. Primary outcomes of the analysis were postoperative mortality for all patients and amputation rates only in those COVID-19 patients suffering from acute lower limb ischemia. Secondary outcomes were the prevalence of the disease among admitted COVID-19 patients, and any possible correlation between inflammatory parameters, thrombolytic status, and the presence of acute ischemia or DVT. Results We observed 38 patients (28 male) with severe COVID-19 infection (6 with lower limb arterial thrombosis and 32 with DVT). The median age was 64 years (range 30-94 years). In the arterial group, 3 had thrombosis on plaque and 3 on healthy arteries ("simple" arterial thrombosis). All underwent operative or hybrid (open/endo) revascularization; 1 patient died from major organ failure (MOF) and one patient underwent major amputation. In the DVT group, 9 (28%) patients died from MOF, despite aggressive medical therapy. In patients with "simple" arterial thrombosis and those with DVT, we observed a decrease in inflammatory parameters (CRP) and in D-dimer and fibrinogen after aggressive therapy (p <0.001). Conclusions Our study confirms that critically ill, COVID-19 patients who develop arterial and deep vein thrombosis are at high risk of mortality, but if treated properly, there is an improvement in overall survival rate, especially in patients of 60 years of age or younger.

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Lessons Learned During the COVID-19 Virus Pandemic

Cited by 51 publications

References 7 publications

The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study

The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study

Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19

Acute arterial and deep venous thromboembolism in COVID-19 patients: Risk factors and personalized therapy

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