A rational approach to manage surgical procedures in COVID Era – A perspective based on experience in a private referral hospital
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COVID-19 disease has imposed challenges in caring for non-Covid elective surgical patients. As elective surgeries become essential, we propose to evaluate our approach and outcomes of surgical procedures performed during the initial period of COVID-19 pandemic so as to provide a road-map for safer approach.We retrospectively evaluated outcomes in patients who underwent essential elective and emergency surgeries during the 5-week period between April 18, 2020 and May 28, 2020. All patients were screened at the front desk on their arrival to identify possible exposure to SARS- CoV-2. Nasopharyngeal swab of patients requiring hospital admission was tested for COVID-19 by quantitative RT-PCR. Patients needing essential elective surgery were taken up for surgery if they tested negative for COVID-19. Emergency procedures were undertaken in a demarcated theatre for COVID after taking level-3 protection without delay. The clinical data was reviewed and analysed.A total of 764 surgical procedures were conducted, of which 70.7% were elective essential surgeries, with 95.4% of these patients being discharged in stable healthy condition. Approximately 23% of the elective and 26% of the emergency surgeries was categorised in the surgical difficulty category III and majority of these were performed under general anesthesia. Postoperative mortality was 1.04%, but the overall mortality rate was approximately 2.5%. Only two patients (0.3%) tested positive for COVID-19 in our series.A robust preoperative screening and testing can enable safe scheduling of essential elective surgeries.Keywords:
Elective surgery
Emergency Surgery
Surgical procedures
Elective surgery
Emergency Surgery
Perforation
Stoma (medicine)
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Because of continuous progression of age surgery of the aged has become a main problem especially in gastric surgery. 282 cases of more than 70 years old patients undergoing gastric operations between 1964 and 1981 are analyzed. There is a majority of emergency operations (62%), only 16% of the ulcer operations were elective. This caused a high mortality rate (total over 40%) compared with 10% in the elective group. Better results could be obtained by a higher elective rate, i.e. earlier diagnosis.
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The results of colon surgery in all individuals aged 80 years or greater at one teaching institution during the 1987-1993 time period were reviewed. Sixty patients, ranging in age from 80 to 92 years, underwent 41 elective operations and 21 emergency procedures. Emergency procedures resulted in death or a major complication in over one-half of patients, and only six were ultimately able to return home. Conversely, elective procedures were relatively well tolerated, and 31 of 37 survivors returned immediately to independent living (P = 0.006). Mortality was 33.3 per cent in emergency cases versus 9.8 per cent in elective operations (P < 0.03). The occurrence of a postoperative complication increased the length of stay by an average of 12 days. These data suggest that elective colon surgery in the elderly produces results little different from the population at large. Conversely, emergency operations are associated with a high morbidity and mortality rate. Age alone should not be a determining factor in who undergoes an elective colon operation. Greater efforts should be made to screen elderly individuals to limit emergency surgery.
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Objective To evaluate the colon and intestinal obstruction in emergency surgery and elective surgery treatment.Methods 60 cases of colon cancer with intestinal obstruction were divided into emergency surgery group and elective surgery group,two groups of surgical procedures and postoperative complication rates were compared.Results The emergency operation group I was 61.5% of resection,while the elective surgery group I was 100%,the operation rate of the two groups There was significant difference(P0.05);emergency surgery rate of postoperative anastomotic leakage,pulmonary infection rate,wound infection rates were 19.2%,11.5%,42.3%,mortality was 7.7%.Elective surgery group had no anastomotic leakage and mortality,pulmonary infection rate was 2.94%,wound infection rate was 5.88%,Comparison of the complications in each group,statistical analysis showed significant difference(P0.05).Conclusion The colon cancer with intestinal obstruction after conservative treatment for elective surgery more effective than emergency surgery.
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In order to establish time trends in surgical rates for peptic ulcer disease, we sent a questionnaire to every surgical department in Sweden. Eighty-two per cent of the departments responded. Since 1956 there was a marked and steady decline in elective procedures (-83%) and to a much lesser extent also in emergency procedures for perforations (-30%). The decline was most pronounced for duodenal ulcer in men. In 1986, the incidence was 1.2 and 0.65 operations per 10,000 inhabitants for elective and emergency operations, respectively. In the future, the few patients needing elective surgery for peptic ulcer may have to be served by a small number of specialized centers.
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Long-term results in QOL of patients over 75 years old after emergent cardiovascular surgery were examined. From January 1991 to June 1996, 46 patients underwent cardiovascular surgery. 22 patients who had elective surgery (elective group) and 15 patients who had emergency surgery (emergency group) tolerated with the operation: Two-year survival rate after surgery was 80.7% in the elective group and 78% in the emergency group, and relative survival rate was 0.89 in the elective group and 0.86 in the emergency group. As regards to the ability to live independently, 89% of elective group and 75% of emergency group showed good improvement, and there was no significant difference between two groups. The rate of patients who did not feel anxiety for disease at all was 61.1% in the elective group and 41.7% in the emergency group. The relationship between the patient and his family was good in both groups. For physical condition, the emergency group was superior to the elective group with no significant difference. Although QOL was relatively good after emergency surgery, some items were inferior compared with elective surgery. To improve the long-term results, elective surgery is required to avoid emergency surgery.
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The decreasing frequency of elective ulcer surgery and the persisting frequency of emergency surgery for peptic ulcer diseases has often been reported. The reason for the divergent epidemiological behaviour of the two subgroups of surgical candidates is not clear. The present cross-sectional, population-based analysis of patients undergoing peptic ulcer surgery evaluates the mode of preoperative therapy in elective and emergency cases. It also assesses the present frequency of peptic ulcer surgery, ulcer complications, and the immediate results of ulcer surgery in a target population. The evaluation concerned 117 adult patients (F/M ratio 1/1.1, mean age 58.7 +/- 1.8 years) operated on for peptic ulcer disease in Helsinki City between March 1990 and February 1991. The annual frequency of elective surgery was 8.3 and of emergency surgery 20.7 per 10(5) residents in Helsinki. 30% of the patients treated surgically had no preoperative symptoms or antiulcer medication; the others were on on-demand type H2-receptor antagonist therapy. Whereas there was no mortality from the elective surgery the mortality rate for the emergency surgery was 10%, mainly due to cardiopulmonary reasons among elderly, high-risk patients. In conclusion, since our previous report for 1987 for the same target population in Helsinki, the incidence of emergency surgery has additionally increased, while the incidence of elective surgery has continuously decreased.
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Objective To compare the clinical effects of emergency surgery and elective surgery for the treatment of obstructive colon cancer.Methods A total of 126 obstructive colon cancer patients were randomly divided into emergency surgery group and elective surgery group from December 2011 to December 2012 in our hospital,63 patients per group.Patients in elective surgery group were treated with elective surgery after conservative treatment and patients in emergency surgery group were treated with emergency surgery after clear diagnosis.The surgical options and postoperative complications were compared and analyzed between two groups.Results The rate of choose colon resectionⅠanastomosis in elective surgery was significant higher than that in emergency surgery(P 0.05).The rate of choose back to the anastomosis of the colon and ostomy in elective surgery was significant lower than that in emergency surgery(P 0.05).The rate of postoperative pulmonary infection,wound infection and anastomotic leakage in elective surgery was significant lower than that in emergency surgery(P 0.05).Conclusion Elective surgery had positive and practical significance for improving the clinical efficacy of patients with obstructive colon cancer,and reducing the incidence of postoperative complications.
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This work concerns the advance scheduling of elective surgery when the operating rooms' capacity utilization by emergency surgery, as well as by elective procedures, is uncertain. New requests for bookings of elective surgery arrive each day. Such procedures preferably would be performed as soon as possible, but admitting too many patients may result in exceeding a day's capacity, possibly necessitating turning away some emergency cases. So the problem facing the hospital at the start of each day is how many of the additional requests for elective surgery to assign for that day. We provide a stochastic dynamic programming model for this aggregate advance scheduling problem. The model has some novel mathematical features. We analyze it and characterize the nature of the optimal policy, which is not necessarily of a control-limit type. Plausible numerical examples which confirm our theoretical results and provide additional insights are reported.
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A retrospective study of all operations done for duodenal or stomach peptic ulcers in 1976-1978 and 1986-1988 was performed so as to evaluate elective and emergency surgery before and after the introduction of H2-receptor antagonists and to evaluate the influence of medical treatment on surgical training in ulcer surgery. The number of elective operations fell by 80%, the number of emergency operations was unchanged. In 1986-1988 the number of elderly patients who underwent emergency surgery increased, no change in age was seen in elective surgery. The rate of complications was unchanged after elective operations, but has increased considerably after emergency surgery in 1986-1988. Surgeons in training performed a greater share of operations, both elective and emergency, but without an increase in complications. The introduction of H2-receptor antagonists has not reduced the number of emergency operations.
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