A worldwide survey on proctological practice during COVID‐19 lockdown (ProctoLock 2020): a cross‐sectional analysis (original) (raw)
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Updates in Surgery
Proctology is one of the surgical specialties that suffered the most during COVID-19 pandemic. Using data from a crosssectional worldwide web survey, we aimed to snapshot the current status of proctologic practice in Italy with differences between three macro areas (North, Centre, South). Specialists affiliated to renowned scientific societies with an interest in coloproctology were invited to join a 27-item survey. Predictive power of respondents' and hospitals' demographics on the change of status of surgical activities was calculated. The study was registered at ClinicalTrials.gov (NCT 04392245). Of 299 respondents from Italy, 94 (40%) practiced in the North, 60 (25%) in the Centrer and 82 (35%) in the South and Islands. The majority were men (79%), at consultant level (70%), with a mean age of 46.5 years, practicing in academic hospitals (39%), where a dedicated proctologist was readily available (68%). Southern respondents were more at risk of infection compared to those from the Center (OR, 3.30; 95%CI 1.46; 7.47, P = 0.004), as were males (OR, 2.64; 95%CI 1.09; 6.37, P = 0.031) and those who routinely tested patients prior to surgery (OR, 3.02; 95%CI 1.39; 6.53, P = 0.005). The likelihood of ongoing surgical practice was higher in the South (OR 1.36, 95%CI 0.75; 2.46, P = 0.304) and in centers that were not fully dedicated to COVID-19 care (OR 4.00, 95%CI 1.88; 8.50, P < 0.001). The results of this survey highlight important factors contributing to the deadlock of proctologic practice in Italy and may inform the development of future management strategies.
Proctologic Surgery Prioritization After the Lockdown: Development of a Scoring System
Frontiers in Surgery, 2022
IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has shown a very critical impact on surgical procedures all over the world. Italy faced the deepest impact from the beginning of March 2020. Elective operations, screening, and follow-up visits had been suspended giving priority to urgent and oncologic surgery.PatientsAn observational study was carried out in the Surgical Coloproctology Unit of the Val Vibrata Hospital on 152 patients awaiting a proctological surgical treatment during the national lockdown.MethodsIn order to monitor the health status of patients and reschedule postlockdown surgical activities, patients were interviewed by telephone submitting a questionnaire based upon the judgment of an expert senior clinician. Following the interview, we calculated a severity index for all the proctologic diseases (hemorrhoidal disease, anal fissure, anal sepsis, slow transit or obstructed defecation, incontinence), classifying the patients according to the score. Mean a...
BJU International, 2020
Objectives To evaluate the risk of contracting severe COVID-19, defined as COVID-19 specific intensive care unit (ICU) admission or death, for patients undergoing urological surgery during the epidemic. To define consequences of receiving surgery for COVID-19 patients. Patients and Methods This is a multicenter observational cohort study. Every patient receiving a urological procedure in Paris academic urological centers during the 4 initial weeks of surgical restrictions were included. Their status was updated minimum 3 weeks after the procedure. The main outcomes were the COVID-19 specific ICU admission and death. Statistics were mostly descriptive. The Post-operative COVID-19 confirmed group was compared with non-COVID patients using Chi-square tests for categorical and Wilcoxon test tests for continuous variables. Results During the 4-week period, 552 patients received surgery within 8 centers. At follow-up, 57 (10%) patients were lost. Among the 11 preoperative COVID-19 cases, one remained in ICU, no new admission, and no death. For the non-COVID patients, 57 (12%) devel-Accepted Article This article is protected by copyright. All rights reserved oped COVID-related symptoms; only one case (0.2%) required COVID-19 specific ICU and 3 (0.6%) patients died of COVID-19 after surgery. Conclusions Performing urological surgery during the COVID-19 epidemic peak has a limited impact on ICU admissions but presents a real (0.6%) risk of specific mortality. Surgical activities should be maintained according to this risk.
From high volume to “zero” proctology: Italian experience in the COVID era
International Journal of Colorectal Disease, 2020
Purpose The coronavirus disease 2019 (COVID-19) pandemic hit Italy early and strongly, challenging the whole health care system. Proctological patients and surgeons are experiencing a previously unseen change in care with unknown repercussion. Here we discuss the proctological experience of 4 Italian hospitals during the COVID-19 pandemic. Methods Following remote brainstorming, the authors summarised their experience in managing proctological patients during the COVID-19 pandemics and put forward some practical observations to further investigate. Results The 4 hospitals shifted from a high-volume proctological activity to almost "zero" visits and surgery. Every patient accessing the hospital must respect a specific COVID-19 protocol. Proctological patients can be stratified based on presentation and management considerations into (1) neoplastic patients, the only allowed to be surgically treated, (2) the ones requiring urgent care, operated only in highly selected cases and (3) the stable, already known patients, managed remotely. Changes in the clinical management of the proctological disease are presented together with some considerations to be explored. Conclusions In the absence of scientific evidence, these practical considerations may be valuable to proctological surgeons starting to face the COVID-19 pandemics. Beside the more clinical considerations, this crisis produced unexpected consequences such as an improvement of the therapeutic alliance and a shift towards telemedicine that may be worth exploring also in the post-COVID-19 era.
Journal of Pediatric and Adolescent Surgery, 2020
Background: During the COVID-19 pandemic, surgical practice is greatly changed as a strategy to prevent infection to the health care workers. This study was done to see what changes have been made in the surgical practice by the surgical consultants and residents in various surgical disciplines. Methods: A Survey form was developed on the “Google Forms” application and distributed to surgical consultants and residents. The submission was received online during May 2020. The collected data were entered and analyzed using SPSS V.23. Qualitative data were presented as frequencies and percentages. Quantitative data were presented as mean and standard deviation. Results: Overall, 272 consultants and residents from 45 teaching hospitals from Pakistan and around the world participated in the survey. Among the participants, 100 (36.8%) were surgical consultants and 172 (63.2%) were surgical residents. About 42% of participants were not performing elective surgeries during this pandemic of C...
Impact of COVID-19 on Urology Practice: A Global Perspective and Snapshot Analysis
Journal of Clinical Medicine
The global impact of the 2019 novel coronavirus disease (COVID-19) pandemic on urology practice remains unknown. Self-selected urologists worldwide completed an online survey by the Société Internationale d’Urologie (SIU). A total of 2494 urologists from 76 countries responded, including 1161 (46.6%) urologists in an academic setting, 719 (28.8%) in a private practice, and 614 (24.6%) in the public sector. The largest proportion (1074 (43.1%)) were from Europe, with the remainder from East/Southeast Asia (441 (17.7%)), West/Southwest Asia (386 (15.5%)), Africa (209 (8.4%)), South America (198 (7.9%)), and North America (186 (7.5%)). An analysis of differences in responses was carried out by region and practice setting. The results reveal significant restrictions in outpatient consultation and non-emergency surgery, with nonspecific efforts towards additional precautions for preventing the spread of COVID-19 during emergency surgery. These restrictions were less notable in East/South...
World Journal of Urology
Objective To determine real life impact during the first pandemic year on diagnosis and surgical management of common urological diseases and 90-day postoperative mortality following common urological surgeries. Methods Cross-sectional study from 2016 to 2021. We used TriNetX to obtain the data. Patients with a diagnosis of six common non-oncologic and five oncologic urologic conditions were included. Twenty-four surgical interventions were also analyzed. The total number of diagnosis and surgical procedures were compared yearly from 2016 to 2021 and Chi-square test was used for statistical analysis. Additionally, monthly changes were evaluated during the first pandemic year and a z score period time was reported. The 90-day post-operative mortality rates during the first pandemic year were compared to the preceding year. Results Overall, a decrease in diagnosis and surgeries were observed during the first pandemic year, with maximum drop in April 2020. Among non-oncological conditions, the decrease in diagnosis of enlarged prostate (5.3%), nephrolithiasis (9.4%), urinary incontinence (18.7%), and evaluation for male sterilization (14.8%) reached statistical significance (P < 0.05 in all). Prostate cancer was the only cancer whose diagnosis showed statistically significant decrease (6.2%, P < 0.05). The surgical case load for benign conditions showed higher reduction (13.1-25%) than for malignant conditions (5.9-16.3%). There was no change in 90-day post-operative mortality in any of the analyzed surgeries. Conclusions Our study showed that although healthcare delivery decreased in the first pandemic year, causing a decline in the diagnosis and surgical treatment of several diseases, surgical interventions did not increase the risk of death.
Decreases in Elective and Non-Elective Surgical Case Volumes During the COVID-19 Pandemic
Journal of Current Surgery
Background: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on surgical healthcare delivery systems. Multiple surgical organizations outlined recommendations on the performance of surgeries to minimize viral transmission, prioritize resource allocation, and avoid perioperative complications. This study aims to characterize the changes in surgical volume during the COV-ID-19 pandemic. Methods: A retrospective chart review was performed at a large public hospital to characterize the surgical case volume, specialties performing surgeries, case urgency (elective vs. non-elective), patient presentation (emergency room, clinic, inpatient), and patient demographics. Data were collected between January 17 and May 8, 2020, 8 weeks prior to and 8 weeks after the declaration of COVID-19 as a national emergency in the USA. For comparison, data between January 17 and May 8, 2019 were also collected. A univariate analysis was performed via paired tests between the two years. Results: There was a statistically significant decrease in both elective and non-elective cases in 2020. When compared to 2019, the weekly case volume in 2020 is significantly higher prior to the declaration of COVID-19 a national emergency (weeks 1-8) and significantly lower after the declaration of COVID-19 as a national emergency (weeks 9-16). Additionally, there appeared to be statistically significant decrease in non-elective surgical case volumes. Conclusions: In facing the challenges presented by the COVID-19 pandemic, clinician leaders have been tasked with making difficult decisions regarding patient care. While leading surgical organizations provided guidelines for best practices at the start of the pandemic, the long-term implications of these decisions are unknown. This study has found that the COVD-19 pandemic has resulted in decreased volume of both elective and non-elective surgeries, raising concerns that necessary care may be delayed for marginalized populations.
Have General Surgery Practices Decreased During the COVID-19 Pandemic?
Cureus, 2022
Background As the coronavirus disease 2019 (COVID-19) pandemic started, some restrictions were imposed throughout the country. The pandemic caused disruption, reduction, and even a halt in health services worldwide. During this period, the number of procedures performed in surgical clinics decreased due to the interruption of services and the restriction in patient admissions. Methodology In this study, we aimed to evaluate the effect of the pandemic on the number of surgeries performed in our clinic during the pre-and post-pandemic period by evaluating the following elective surgeries conducted between September 2018 and September 2021: upper gastrointestinal system, abdominal wall hernia, gallbladder surgeries, and kidney transplantation. Results A significant decrease was observed in the number of operations before and after the pandemic in our clinic. Conclusions In our opinion, both the Ministry of Health and healthcare institutions should increase the necessary precautions, organize the planning and programming in hospitals, and increase efforts in protecting healthcare workers and patients by increasing surgical practices and ensuring that the healthcare services we provide reach the numbers noted during the pre-pandemic period.