scholarly journals 575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Chatzikonstantinou ◽  
A Pouncey ◽  
M l David ◽  
F Aljarad ◽  
P Sorelli
Keyword(s):  
Acute Appendicitis ◽  
General Surgery ◽  
Emergency Services ◽  
Surgical Patients ◽  
Queen Elizabeth Hospital ◽  
Single Centre ◽  
Open Procedure ◽  
Negative Appendicectomy ◽  
Surgery Department ◽  
The Impact

Abstract Introduction The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients. Aim To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG. Method A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019. Results A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019. Conclusions There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.

scholarly journals 579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Chatzikonstantinou ◽  
M David ◽  
A Pouncey ◽  
F Aljarad ◽  
P Sorelli
Keyword(s):  
General Surgery ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Emergency Operation ◽  
Queen Elizabeth Hospital ◽  
Local Data ◽  
Number Of Patients ◽  
Few Data ◽  
Surgery Department ◽  
The Impact

Abstract Background The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery. Aim To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19. Method Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team. Results A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19). Conclusions CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.

A SURGICAL AUDIT OF GENERAL SURGERY CASES IN A TERTIARY CARE HOSPITAL AND THE IMPACT OF COVID-19 ON THE SAME

2021 ◽  
pp. 39-41
Author(s):  
Ravi Landge ◽  
Sumit Satish Malgaonkar ◽  
Girish Bakhshi ◽  
Ajay Bhandarwar ◽  
Jaymin Gupta
Keyword(s):  
General Surgery ◽  
Emergency Services ◽  
Tertiary Care ◽  
World Health ◽  
Care Hospital ◽  
Real Risk ◽  
Health Organization ◽  
Surgical Audit ◽  
Surgery Department ◽  
The Impact

BACKGROUND: After the COVID-19 pandemic was declared on March 11, 2020 by the World Health Organization (WHO), routine clinical and surgical practices were affected, including General Surgery services. We aimed to compare how our General Surgery department was affected during this time period of Covid, we have included various parameters, we have also statistically shown how the elective and emergency services were before the Covid outbreak and during the COVID-19 pandemic in our institution. MATERIAL AND METHODS: We retro spectively compared General Surgery practices, including elective, emergency and septic surgeries in a surgical unit of Sir JJ Group of Hospitals over a span of 3 years (April 2018 - March 2021), including the era before and during Covid. RESULTS: The frequency of all the surgeries performed during the pandemic was lower as compared to previous two years before the pandemic in our study, also there was a signicant drop in the number of laparoscopic surgeries. CONCLUSION: The General Surgery practices in our institution have been drastically affected by the COVID-19 pandemic. This setback needs a denite strategy to be formulated to decrease the morbidity and mortality from the neglected elective surgical cases, the real risk-benet ratio must be met before operating such cases.

scholarly journals Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1185
Author(s):  
Eleni Karlafti ◽  
Emmanouil S. Benioudakis ◽  
Daniel Paramythiotis ◽  
Konstantinos Sapalidis ◽  
Georgia Kaiafa ◽  
...  
Keyword(s):  
General Surgery ◽  
Control Period ◽  
Mortality Rates ◽  
Common Type ◽  
First Year ◽  
Emergency General Surgery ◽  
Time Periods ◽  
Surgery Department ◽  
The Impact ◽  
Type Of Surgery

Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.

scholarly journals SP4.1.4 Stay at home, protect the NHS, Save lives? The impact of the COVID-19 pandemic on acute surgical services

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Oliver Brewster ◽  
Dale Thompson ◽  
Emma Sewart ◽  
Sarah Richards
Keyword(s):  
Abdominal Pain ◽  
General Surgery ◽  
District General Hospital ◽  
Surgical Patients ◽  
Emergency Admissions ◽  
Emergency Operations ◽  
Surgical Services ◽  
The Mean ◽  
The Impact ◽  
Second Wave

Abstract Aims Several centres described a ‘lockdown effect’: a reduction in emergency surgical admissions during national lockdown (23/03/20-01/06/20). The extent and reproducibility of this is unclear. We evaluated the impact of the COVID-19 pandemic on emergency general surgical activity in a district general hospital. Methods We conducted a retrospective analysis of patients admitted under general surgery and urology between 01/01/2017-31/12/2020 using coding data. Unpaired t-tests were used to compare the total monthly admissions, admissions by diagnosis and monthly operations performed between the ‘first wave’ (April-May 2020) and ‘average’ (all months 2017-2019), and between the ‘second wave’ (November-December 2020) and average. Results Overall emergency admissions in 2020 were reduced compared to the mean 2017-2019 (4498 vs 5037). Monthly admissions were significantly reduced in the first wave compared to 2017-2019 (mean monthly admissions=284.5 vs 419.8; p &lt; 0.001) with the greatest reduction in patients with non-specific abdominal pain (mean=58 vs 109; p = &lt;0.001). A significant reduction in monthly admissions with pancreatitis (mean=8.0 vs 14.6; p = 0.010) and diverticulitis (mean=10.5 vs 18.8; p = 0.028) were also observed. This effect was less apparent during the second wave (mean total admissions=384.5 vs 419.8; p = 0.249). Monthly emergency operations were reduced in both the first wave compared to average (68 vs 101.9; p = 0.007) and the second wave (74.5 vs 101.9; p = 0.025). Conclusions We found strong evidence of a ‘lockdown effect’ in our centre during the first wave. The cause is unclear and likely to be multifactorial. Further research is needed to evaluate whether surgical patients came to harm as a result.

scholarly journals SP2.2.14Evaluating the benefits of increasing exposure to the operating theatre for Foundation Year One Trainees in General Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Armin Fardanesh ◽  
Charlotte Boardman ◽  
Maitham Al-Whouhayb ◽  
Pawan Mathur ◽  
Martin Klein
Keyword(s):  
General Surgery ◽  
Surgical Skills ◽  
Operating Theatre ◽  
Surgical Patients ◽  
Practical Skills ◽  
Structured Interviews ◽  
Direct Exposure ◽  
Recovery Pathways ◽  
The Impact

Abstract Aims Many foundation year one (FY1) doctors report little exposure to the operating theatre. Surgical departments welcome FY1s in theatres, but ward duties often prevent them from achieving direct exposure to operations. Following the implementation of specific days on the timetable dedicated to attending the operating theatre, this project aimed to reflect on the impact on FY1 training in General Surgery. Methods Structured interviews were held with the 9 FY1 doctors who were 2 months into their rotation in General Surgical block. Results All FY1s believed that assisting in operations added to their experience of the specialty. They reported increased understanding of the procedures and recovery pathways for their patients, which improved their ability to manage these patients peri-operatively. As expected, seven FY1s confirmed that they did not have the opportunity on non-allocated days to attend theatre due to “being busy on the ward” and not wanting to “give the others more work”. Two FY1s who intend on pursuing a career in surgery described additional benefits including the opportunity to gain practical skills and build a surgical logbook. Conclusion One of the main barriers for FY1s wanting to attend theatre sessions is an excessive ward workload. By allocating theatre days on the rota this challenge was overcome and the benefits of attending theatre are evident. Regular exposure to the operating theatre improves foundation training in General Surgery by increasing understanding and confidence in managing surgical patients and assisting prospective surgical applicants with early, supervised surgical skills practice.

scholarly journals Infections by OXA-48 carbapenemase-producing Enterobacteriaceae in surgical patients: antibiotic consumption and susceptibility patterns

2020 ◽  
Vol 33 (6) ◽  
pp. 448-452
Author(s):  
Ismael Mora-Guzmán ◽  
Inés Rubio-Pérez ◽  
Diego Domingo-Garcia ◽  
Elena Martín-Pérez
Keyword(s):  
General Surgery ◽  
Temporal Trends ◽  
Antibiotic Consumption ◽  
Targeted Treatment ◽  
Surgical Patients ◽  
Abdominal Infection ◽  
Combination Scheme ◽  
Intra Abdominal Infection ◽  
Surgery Department ◽  
Susceptibility Patterns

Objective. To assess antibiotic consumption, susceptibility patterns and targeted treatment for OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) related infections in surgical patients in a General Surgery Department. Material and methods. Retrospective review of patients with a positive culture for OXA-48 and associated clinical data of infection, while hospitalized in a General Surgery Department from January 2013 to December 2018. Results. Sixty-five patients with 66 isolations (OXA-48) were included: Klebsiella pneumoniae, 57 (86.5%); Enterobacter cloacae, 5 (7.6%); Escherichia coli, 3 (4.5%); Morganella morganii, 1 (1.5%). The most frequent source was intra-abdominal infection (n=39, 60%), and previous antibiotic consumption was: piperacillin-tazobactam (48%), meropenem (45%), ciprofloxacin (25.5%), ertapenem (16.5%), imipenem (12%), amikacin (12%), tigecycline (12%). Temporal trends (2013/14, 2015/16 and 2017/18) in susceptibility patterns were (percentages): ceftazidime-avibactam X-X-100; amikacin 100- 96-84 (p=0.518); tigecycline 100-92-80 (p=0.437); colistin 100-67-66 (p<0.001); meropenem 37-64-72 (p=0.214); imipenem 51-41-77 (p=0.109); gentamicin 13-19-18 (p=0.879); ertapenem 35-0-0 (p<0.001). Median duration of the targeted antibiotic therapy was 14 [IQR 9-20] days; antibiotics used were: tigecycline (57%); meropenem (40.5%); amikacin (37.5%); ceftazidime-avibactam (9%); imipenem (7.5%); colistin (7.5%). Global mortality rate at 30 days was 12% (8 patients). Targeted treatment was appropriate (antibiogram) in 87.7%, and targeted combination scheme was administered in 76.9%, which included a carbapenem in 49.2%. Conclusions. OXA-48-related-intra-abdominal infection is significant in surgical patients, with substantial broad-spectrum antibiotic consumption. Useful targeted therapy includes ceftazidime-avibactam, amikacin, tigecycline, meropenem, and imipenem.

scholarly journals 353 AIR Score Based Management of Appendicitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Carlile
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
General Surgery ◽  
Diagnostic Laparoscopy ◽  
Open Appendicectomy ◽  
Common Cause ◽  
Retrospective Audit ◽  
Negative Appendicectomy ◽  
Score Risk

Abstract Introduction Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis. Aim This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital. Method All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018. Results The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use. Discussion Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.

scholarly journals The IMPACT OF CLINICAL PHARMACY SERVICES IN GENERAL SURGERY

2020 ◽  
pp. 63-66
Author(s):  
PRADEEP BATTULA ◽  
B. TEJASWINI ◽  
M. P. HAREEN SHANKAR ◽  
T. SAI YASHODA KRISHNA ◽  
V. BRAHMA REDDY
Keyword(s):  
General Surgery ◽  
Pharmacy Services ◽  
Drug Related Problems ◽  
Interventional Study ◽  
Related Research ◽  
Treatment Factor ◽  
Surgery Department ◽  
The Impact ◽  
Care Outcome ◽  
Health Care Outcome

Objective: The objectives of this study include performing pharmaceutical care-related research and documenting regarding drug-related problems in the surgery department. Further, these types of studies may bring consciousness to both physicians and patients regarding drug use in surgery. Methods: A Prospective interventional study was conducted in a general surgery hospital. The prescriptions were analyzed for the use of inappropriateness of drugs using the classification for drug-related problems. Results: Out of 100 cases, 62 patients were observed with drug-related problems. The number of antibiotics prescribed was 0, 1, 2, 3, 4, 5, 6 in 8, 11, 12, 32, 18, 18, 1 cases respectively. A significant increase in the outcome of antibiotic rationality and cases adhered to guidelines was seen in November compared to October and somewhat decreased in December due to some limitations. The overall study states that prescribing has a more important cause of Drug-related problems compared to dispensing and the use of the drug. Conclusion: Drug-related problems have to be acknowledged as a very important contributing treatment factor for the best health care outcome. Our study shows the importance of clinical pharmacists in every hospital for identifying and resolving drug-related problems and medication errors.

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