Abstract:Background
In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures a… Show more
“…However, after the first wave of the pandemic, the number of cancer surgeries began to rise gradually [ 29 ]. Additionally, several studies have now reported on safe pathways to perform “non-urgent” cancer surgeries with minimal complications due to COVID-19 [ 30 , 31 , 32 , 33 ].…”
The SARS-CoV-2 (COVID-19) pandemic is having a large effect on the management of cancer patients. This study reports on the approach and outcomes of cancer patients receiving radical surgery with curative intent between March and September 2020 (in comparison to 2019) in the European Institute of Oncology, IRCCS (IEO) in Milan and the South East London Cancer Alliance (SELCA). Both institutions implemented a COVID-19 minimal pathway where patients were required to self-isolate prior to admission and were swabbed for COVID-19 within 72 h of surgery. Positive patients had surgery deferred until a negative swab. At IEO, radical surgeries declined by 6% as compared to the same period in 2019 (n = 1477 vs. 1560, respectively). Readmissions were required for 3% (n = 41), and <1% (n = 9) developed COVID-19, of which only one had severe disease and died. At SELCA, radical surgeries declined by 34% (n = 1553 vs. 2336). Readmissions were required for 11% (n = 36), <1% (n = 7) developed COVID-19, and none died from it. Whilst a decline in number of surgeries was observed in both centres, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.
“…However, after the first wave of the pandemic, the number of cancer surgeries began to rise gradually [ 29 ]. Additionally, several studies have now reported on safe pathways to perform “non-urgent” cancer surgeries with minimal complications due to COVID-19 [ 30 , 31 , 32 , 33 ].…”
The SARS-CoV-2 (COVID-19) pandemic is having a large effect on the management of cancer patients. This study reports on the approach and outcomes of cancer patients receiving radical surgery with curative intent between March and September 2020 (in comparison to 2019) in the European Institute of Oncology, IRCCS (IEO) in Milan and the South East London Cancer Alliance (SELCA). Both institutions implemented a COVID-19 minimal pathway where patients were required to self-isolate prior to admission and were swabbed for COVID-19 within 72 h of surgery. Positive patients had surgery deferred until a negative swab. At IEO, radical surgeries declined by 6% as compared to the same period in 2019 (n = 1477 vs. 1560, respectively). Readmissions were required for 3% (n = 41), and <1% (n = 9) developed COVID-19, of which only one had severe disease and died. At SELCA, radical surgeries declined by 34% (n = 1553 vs. 2336). Readmissions were required for 11% (n = 36), <1% (n = 7) developed COVID-19, and none died from it. Whilst a decline in number of surgeries was observed in both centres, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.
“…COVID-19 patients may potentially expose healthcare providers to the risk of contamination during surgical and anesthetic procedures [ 4 ], and positivity cases and some deaths are already occurring among health workers [ 5 , 6 ]. In this scenario, the surgical community had been pushed to rapidly understand how to deal with the virus's presence and organize the gradual resumption of surgical activity [ 7 ].…”
Background
The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic.
Methods
The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020).
Results
Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices.
Conclusion
This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.
“…There have been no consistent statements on surgical guidelines regarding the perioperative screening of COVID-19 patients. Bellato et al [2] revealed the global situation of surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic in early April 2020 in a cross-sectional online survey of 936 centres. In 71.9% of the centres, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings, while in 18.4% a universal testing was recommended.…”
Section: Discussionmentioning
confidence: 99%
“…In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes [1]. A large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice [2].…”
Section: Introductionmentioning
confidence: 99%
“…Whether PCR testing should be performed for all or selected elective surgery patients, even those who are asymptomatic, remains unclear, and available data regarding a universal strategy or high risk surgeries limited model effectiveness has been limited [2,3]. To maintain a safe environment for all patients and health care workers (HCW), in our health area we established an admission screening plan of testing for SARS-CoV-2, giving priority to surgical procedures with potential risk of adverse surgery outcomes related to the presence of asymptomatic patients who were infected with the virus upon admission.…”
On behalf of COVID19-ALC research group, Effectiveness of a SARS-CoV-2 infection-prevention model in elective surgery patients, a prospective study: Does Universal Screening Make Sense?.
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