Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, electiv... more Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, elective surgery was discontinued and outpatient clinics were cancelled or altered to phone consultations1-5. Anecdotal evidence suggests a reduction of acute surgical admissions, however there is paucity of studies looking into the causative factors. It was anticipated by some that as a result of the ‘lock-down’ patients would deteriorate at home without access to hospital treatment, leading to late presentations. We performed a multicentre study at sixteen hospitals aiming to evaluate the patients with acute surgical inflammatory processes (ASIP) (appendicitis, cholecystitis, diverticulitis and perianal abscesses) during the COVID-19 outbreak and compare it with the same timeframe in 2019. Consecutive patients from March 14th 2020 (date of the declaration of the state of alarm by Spanish Government) until the May 2th 2020 (beginning of the gradual de-escalation plan) were included. In total, 521 patients were treated for ASIP in 2020 (cases) and 822 in 2019 (controls). This represents a 36⋅6% (appendicitis -33⋅4%, cholecystitis -22⋅9%, diverticulitis -60% anal perianal abscesses -41%) reduction. The higher reduction was observed in mild and moderate cases (-49⋅3% and -19⋅5%, respectively), with a similar number of severe cases (86 vs. 97; variation -11⋅3%). The percentage of patients treated surgically was lower in 2020 (380 [72⋅9%] vs. 658 [80%]; p = 0⋅002). Although the cases group had more complications (117 [22⋅5%] vs. 101 [12⋅3%]; p< 0⋅001) the number of severe complications (grade 3 Table 1 Logistic regression analysis
... en un hospital de referencia Zoilo Madrazo, Leonardo Silvio-Estaba, Luis Secanella, Arantxa G... more ... en un hospital de referencia Zoilo Madrazo, Leonardo Silvio-Estaba, Luis Secanella, Arantxa García-Barrasa, Humberto Aranda, Thomas Golda, Sebastiano Biondo y Antoni Rafecas Servicio de Cirugía General y Aparato Digestivo. ... 5. Suarez CA, Arango A, Lester JL. ...
Abstract Infection with the SARS-CoV-2 virus seems to contribute significantly to increased posto... more Abstract Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients. A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the “pandemic” cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the “control” cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients. The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings. ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, electiv... more Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, elective surgery was discontinued and outpatient clinics were cancelled or altered to phone consultations1-5. Anecdotal evidence suggests a reduction of acute surgical admissions, however there is paucity of studies looking into the causative factors. It was anticipated by some that as a result of the ‘lock-down’ patients would deteriorate at home without access to hospital treatment, leading to late presentations. We performed a multicentre study at sixteen hospitals aiming to evaluate the patients with acute surgical inflammatory processes (ASIP) (appendicitis, cholecystitis, diverticulitis and perianal abscesses) during the COVID-19 outbreak and compare it with the same timeframe in 2019. Consecutive patients from March 14th 2020 (date of the declaration of the state of alarm by Spanish Government) until the May 2th 2020 (beginning of the gradual de-escalation plan) were included. In total, ...
Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is pr... more Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-hour, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinic... more Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinical alternative to blood transfusion. This review article summarises the main characteristics of the different formulations of parenteral iron, their advantages, indications, dosages and adverse effects. Moreover, we analyse some of the most important published articles on parenteral iron therapy in General Surgery and other surgical specialties, as well as providing information about new formulations that will soon be available.
Background Few surgical studies have provided adjusted comparative postoperative outcome data amo... more Background Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. Methods Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. Results Some 5307 patients were included in the study (183 COVID-19-positive and 2132 C...
About 25-35% of polytraumatized patients have a profound alteration of hemostasis on arrival at t... more About 25-35% of polytraumatized patients have a profound alteration of hemostasis on arrival at the hospital (acute traumatic coagulopathy [CAT]). Viscoelastic tests (ROTEM®) measure the hemostatic capacity and provide an early detection of CAT. The objectives of this study are to describe the initial thromboelastogram of these patients and to determine the prevalence of CAT according to predefined thromboelastographic profiles. Single-center, observational, prospective study in polytraumatic patients. Initial blood and thromboelastographic test (ROTEM®) were made, and pre-hospital, hospital, transfusion, initial surgical/angiographic interventions, cardiac arrest and mortality data were collected. ROTEM®-based, patients were classified as: normal, hypercoagulable, hypocoagulable, hipocoagulable +hyperfibrinolytic and isolated hyperfibrinolysis. One hundred and twenty-three patients were analyzed. 32 cases (26%) with CAT: 15 patients with hypocoagulability, 9 with hyperfibrinolysis ...
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, electiv... more Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, elective surgery was discontinued and outpatient clinics were cancelled or altered to phone consultations1-5. Anecdotal evidence suggests a reduction of acute surgical admissions, however there is paucity of studies looking into the causative factors. It was anticipated by some that as a result of the ‘lock-down’ patients would deteriorate at home without access to hospital treatment, leading to late presentations. We performed a multicentre study at sixteen hospitals aiming to evaluate the patients with acute surgical inflammatory processes (ASIP) (appendicitis, cholecystitis, diverticulitis and perianal abscesses) during the COVID-19 outbreak and compare it with the same timeframe in 2019. Consecutive patients from March 14th 2020 (date of the declaration of the state of alarm by Spanish Government) until the May 2th 2020 (beginning of the gradual de-escalation plan) were included. In total, 521 patients were treated for ASIP in 2020 (cases) and 822 in 2019 (controls). This represents a 36⋅6% (appendicitis -33⋅4%, cholecystitis -22⋅9%, diverticulitis -60% anal perianal abscesses -41%) reduction. The higher reduction was observed in mild and moderate cases (-49⋅3% and -19⋅5%, respectively), with a similar number of severe cases (86 vs. 97; variation -11⋅3%). The percentage of patients treated surgically was lower in 2020 (380 [72⋅9%] vs. 658 [80%]; p = 0⋅002). Although the cases group had more complications (117 [22⋅5%] vs. 101 [12⋅3%]; p< 0⋅001) the number of severe complications (grade 3 Table 1 Logistic regression analysis
... en un hospital de referencia Zoilo Madrazo, Leonardo Silvio-Estaba, Luis Secanella, Arantxa G... more ... en un hospital de referencia Zoilo Madrazo, Leonardo Silvio-Estaba, Luis Secanella, Arantxa García-Barrasa, Humberto Aranda, Thomas Golda, Sebastiano Biondo y Antoni Rafecas Servicio de Cirugía General y Aparato Digestivo. ... 5. Suarez CA, Arango A, Lester JL. ...
Abstract Infection with the SARS-CoV-2 virus seems to contribute significantly to increased posto... more Abstract Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients. A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the “pandemic” cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the “control” cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients. The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings. ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, electiv... more Editor Since the first case of SARS-CoV-2 was confirmed, lives were altered in many ways, elective surgery was discontinued and outpatient clinics were cancelled or altered to phone consultations1-5. Anecdotal evidence suggests a reduction of acute surgical admissions, however there is paucity of studies looking into the causative factors. It was anticipated by some that as a result of the ‘lock-down’ patients would deteriorate at home without access to hospital treatment, leading to late presentations. We performed a multicentre study at sixteen hospitals aiming to evaluate the patients with acute surgical inflammatory processes (ASIP) (appendicitis, cholecystitis, diverticulitis and perianal abscesses) during the COVID-19 outbreak and compare it with the same timeframe in 2019. Consecutive patients from March 14th 2020 (date of the declaration of the state of alarm by Spanish Government) until the May 2th 2020 (beginning of the gradual de-escalation plan) were included. In total, ...
Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is pr... more Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-hour, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinic... more Parenteral iron is a useful and safe therapeutic measure to treat anaemia, and is a proven clinical alternative to blood transfusion. This review article summarises the main characteristics of the different formulations of parenteral iron, their advantages, indications, dosages and adverse effects. Moreover, we analyse some of the most important published articles on parenteral iron therapy in General Surgery and other surgical specialties, as well as providing information about new formulations that will soon be available.
Background Few surgical studies have provided adjusted comparative postoperative outcome data amo... more Background Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. Methods Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. Results Some 5307 patients were included in the study (183 COVID-19-positive and 2132 C...
About 25-35% of polytraumatized patients have a profound alteration of hemostasis on arrival at t... more About 25-35% of polytraumatized patients have a profound alteration of hemostasis on arrival at the hospital (acute traumatic coagulopathy [CAT]). Viscoelastic tests (ROTEM®) measure the hemostatic capacity and provide an early detection of CAT. The objectives of this study are to describe the initial thromboelastogram of these patients and to determine the prevalence of CAT according to predefined thromboelastographic profiles. Single-center, observational, prospective study in polytraumatic patients. Initial blood and thromboelastographic test (ROTEM®) were made, and pre-hospital, hospital, transfusion, initial surgical/angiographic interventions, cardiac arrest and mortality data were collected. ROTEM®-based, patients were classified as: normal, hypercoagulable, hypocoagulable, hipocoagulable +hyperfibrinolytic and isolated hyperfibrinolysis. One hundred and twenty-three patients were analyzed. 32 cases (26%) with CAT: 15 patients with hypocoagulability, 9 with hyperfibrinolysis ...
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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