European Surgery-Acta Chirurgica Austriaca最新文献

Background: Some medical disciplines have reported a strong decrease of emergencies during the coronavirus disease 2019 (COVID-19) pandemic; however, the effect of the lockdown on general surgery emergencies remains unclear.

Methods: This study is a retrospective, multicenter analysis of general surgery emergency operations performed during the period from 1 March to 15th 2020 lockdown and in the same time period of 2019 in three medical centers providing emergency surgical care to the area Salzburg-North, Austria.

Results: In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 lockdown (p = 0.005). The length of hospital stay was reduced to 3 days in 2020 compared to 4 in 2019. Appendectomy remained the most performed emergency surgery for both periods; however the number of surgeries was reduced to less than a half, with 72 cases in 2019 and 33 cases in 2020 (p = 0.118). Emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. The strongest reduction in frequencies of emergency surgeries was reported from the designated COVID center in the examined region.

Conclusions: Emergency general surgery is an essential service that continues to run under all circumstances. Our data show that COVID-19-related restrictions have resulted in a significant decrease in the utilization of acute surgical care.

Background: Soon after its appearance, the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) became a pandemic, with over 111 million cases reported and 2.4 million deaths worldwide. Although the focus of public health systems must lie on patients' care and treatment, SARS-COV‑2 infection has also affected surgical trainees in their academic and professional development, causing significant disruption in all forms of their training.

Methods: The aims of this study were firstly to assess the impact of SARS-CoV‑2 on core surgical training, regarding operative, educational and academic skills, as well as the general effect on psychological status and well-being of surgical trainees at a tertiary center in Greece. All core surgical trainees (17) in the general surgery department at the University Hospital of Patras were invited to participate in a voluntary anonymous survey via printed questionnaires.

Results: Junior trainees and senior surgical trainees performed or assisted in almost 50% fewer cases in the COVID era when compared with the period reported before the virus. As far as courses, conferences and exams attended by trainees are concerned, a significant reduction in numbers (six vs 35) before and after the start of COVID-19 pandemic was apparent. In all, 10 (62.5%) trainees felt that their confidence in the operating theatre had been negatively impacted by the pandemic, while four (25%) trainees felt significant stress levels as a result of the national lockdown.

Conclusions: It is imperative for surgical educators to design and implement new alternative ways to assist surgical trainees in their education and also avoid their undertraining during the pandemic.

Background: The purpose of this survey-based study was to evaluate the implementation of virtual learning in a single academic general surgery program, compared with the well-established face-to-face academic curriculum used before.

Methods: From April 2020 to the present, virtual sessions were created via Zoom Videos Communications, Inc. (San Jose, CA, USA). A survey composed of 15 questions about the perceived quality and utility of the virtual sessions was developed. The survey was sent out to all general surgery residents of a general surgery program in November of 2020.

Results: All residents enrolled in the program answered the survey, i.e., 22 (73.3%) men and 8 (26.7%) women with 6 (20.2%) residents per year (PGY 1-PGY 5). Over half of residents (n = 17, 56.7%) felt similar academic performance during online sessions when compared to the older model. Perceptions of the level of organization of academic sessions increased during the online model (n = 20, 66.7%). Twenty (66.7%) residents agreed it was easier to attend sessions during the online model. Fourteen (46.7%) residents reported their attendance to the sessions increased, and 14 (46.7%) residents would prefer this modality after the pandemic is over, with 8 (26.7%) being neutral about it.

Conclusion: This study, to our knowledge, is the first to survey general surgery residents about the transition from a face-to-face curriculum to an e‑learning curriculum. The demonstrated effectiveness of the transition from face-to-face academic activities to virtual activities makes it a feasible tool for graduate medical education programs to adjust to a virtual model.

Background: It is generally expected that emergency laparotomies performed at night confer a higher risk and thus outcomes are worse. This study hopes to determine whether there is a difference in risk of cases presenting at night, and overall outcome.

Methods: Data were retrospectively obtained using local notes archival software to obtain predicted and observed mortality, ASA (American Society of Anesthesiologists) grade and length of stay of emergency laparotomies conducted between August 2019 and March 2020. Day cases were defined as knife to skin time (KTS) between 08:00 and 19:59, whilst night cases were defined as KTS between 20:00 and 07:59.

Results: In all, 81 emergency laparotomies were performed during day-time hours over the 8‑month period; 32 were performed overnight. Median ASA grade was 3 for both. Median length of stay was similar: 11 day, 12 overnight. Median P-POSSUM (Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity) morbidity score of day cases was 52% compared to 53.2% at night. Median mortality score of day cases was 5.6%, whilst at night was 2.7% (p = 0.27). Observed mortality after day cases was 13.5%, and overnight was 9.3%. Observed morbidity was 46.9% after day cases and 50% overnight.

Conclusion: There was no statistically significant difference between predicted or observed morbidity and mortality between emergency laparotomies conducted during the day and those conducted overnight.

Background: The COVID-19 global pandemic left the unprepared health care systems struggling to mount a measured response. This gave rise to important questions about surgeons' attitude towards surgical practice and the level of preparation at work.

Methods: Cross-sectional web-based national survey distributed to general surgeons by e‑mail over a period of 7 days.

Results: Among 304 responders, 42.6% were working in the hospital with COVID-19 patients. Three quarters of all surgeons (74.5%) were afraid of contracting the disease. While 42% expressed a fear for their own life while caring for COVID-19 patients, 90.1% were afraid of transmitting the disease to family members. The average reported level of PPE provided at the workplace was significantly higher among the group which was not afraid of contracting COVID-19 than among the group afraid of contracting COVID-19 (4.0 vs. 3.12, p = 0.02). Nearly all surgeons (93.8%) agreed that cancer surgeries should be continued during the pandemic and 49% perceived laparoscopy as a safe approach when operating on COVID-19 positive patients.

Conclusion: A high proportion of surgeons admitted being afraid of working during the COVID-19 pandemic, which had various implications for their attitude towards surgical practice. Protecting health care workers is an important component of public health measures for addressing the epidemic.