R. Singhal, I. Omar, B. Madhok, Yashasvi Rajeev, Yitka Graham, K. Mahawar
Abstract Background The progressive growth of the older patients with obesity represents a challenge to the weight management teams. Although initially, old age was a relative contraindication to the surgical option, current advances in laparoscopic techniques and perioperative optimization protocols have changed the old notion. However, the performance of bariatric procedures in the older patients during the ongoing COVID-19 pandemic carries a potential risk. This study aimed to assess the safety of bariatric surgery (BS) in older patients during the pandemic. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - older patients ≥65-year-old (Group I) and young < 65-year-old (Group II). Two groups were compared for 30-day morbidity and mortality. Results We included 7084 patients, the mean age was 40.35±11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively. The overall comorbidities were significantly higher in Group I, p= <0.001. In Group II, 14.8% were current smokers, compared to 7.4% of Group I. The complications in Group I were significantly higher (11.4%) compared to Group II (6.6%), p= 0.022. However, the mortality rate and COVID-19 infection within 30 days were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic in the older patients (≥65 years old) is associated with a higher complication rate than the younger age group. However, the mortality and postoperative COVID-19 infection rates are comparable to the younger age group.
{"title":"SP2.1.1 Safety of Bariatric Surgery in The Older Patients During the COVID-19 Pandemic","authors":"R. Singhal, I. Omar, B. Madhok, Yashasvi Rajeev, Yitka Graham, K. Mahawar","doi":"10.1093/bjs/znac247.015","DOIUrl":"https://doi.org/10.1093/bjs/znac247.015","url":null,"abstract":"Abstract Background The progressive growth of the older patients with obesity represents a challenge to the weight management teams. Although initially, old age was a relative contraindication to the surgical option, current advances in laparoscopic techniques and perioperative optimization protocols have changed the old notion. However, the performance of bariatric procedures in the older patients during the ongoing COVID-19 pandemic carries a potential risk. This study aimed to assess the safety of bariatric surgery (BS) in older patients during the pandemic. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - older patients ≥65-year-old (Group I) and young < 65-year-old (Group II). Two groups were compared for 30-day morbidity and mortality. Results We included 7084 patients, the mean age was 40.35±11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively. The overall comorbidities were significantly higher in Group I, p= <0.001. In Group II, 14.8% were current smokers, compared to 7.4% of Group I. The complications in Group I were significantly higher (11.4%) compared to Group II (6.6%), p= 0.022. However, the mortality rate and COVID-19 infection within 30 days were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic in the older patients (≥65 years old) is associated with a higher complication rate than the younger age group. However, the mortality and postoperative COVID-19 infection rates are comparable to the younger age group.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90070161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim Day case surgery is an effective and economical method to manage patients while maintaining quality of care. During the COVID-19 pandemic and the reinstatement of non-cancerous elective surgery, efficient use of bed space capacity has been crucial. Strategies were implemented to reduce unplanned admission rates, including careful patient selection and preoperative assessment. We aimed to review rates of unplanned admissions (UA) following intended day case procedures and to identify methods of future prevention of UA. Methods A retrospective review was carried out of patients undergoing day case hernia repairs or laparoscopic cholecystectomy in a single district general hospital, between May 2021 and September 2021. Data was collated from an institutional data base with follow up data obtained from an electronic care record. Results 53 patients included, with a median age of 76 years (range 23–79), 56.6% male, 23 inguinal hernia repairs and 30 cholecystectomies. 30.2% were unexpectedly admitted post operatively (9 Cholecystectomies and 7 inguinal hernias). Of those admitted, median length of stay was 3.1 days (range2–10). Reason for admission included pain (43.8%), post-operative complications (18.8%) and urinary retention (18.8%). Patients requiring admission were significantly older (mean age 62 vs 49 years old), were more likely to be male (62.5% vs 37.5%) and had a significantly longer theatre time (1.46 vs 1.08 hours, p=0.0001). Conclusions Our short review has identified older and male patient are more likely to require an overnight admission. Improvement in pain management, theatre planning and streamlining along with optimal discharge planning may reduce the volume of patient requiring UA.
{"title":"TU7.1 “When Can I Go Home?”- Unplanned Admissions following day case elective surgery","authors":"L. Armstrong, P. Hughes, P. McLoughlin","doi":"10.1093/bjs/znac248.063","DOIUrl":"https://doi.org/10.1093/bjs/znac248.063","url":null,"abstract":"Abstract Aim Day case surgery is an effective and economical method to manage patients while maintaining quality of care. During the COVID-19 pandemic and the reinstatement of non-cancerous elective surgery, efficient use of bed space capacity has been crucial. Strategies were implemented to reduce unplanned admission rates, including careful patient selection and preoperative assessment. We aimed to review rates of unplanned admissions (UA) following intended day case procedures and to identify methods of future prevention of UA. Methods A retrospective review was carried out of patients undergoing day case hernia repairs or laparoscopic cholecystectomy in a single district general hospital, between May 2021 and September 2021. Data was collated from an institutional data base with follow up data obtained from an electronic care record. Results 53 patients included, with a median age of 76 years (range 23–79), 56.6% male, 23 inguinal hernia repairs and 30 cholecystectomies. 30.2% were unexpectedly admitted post operatively (9 Cholecystectomies and 7 inguinal hernias). Of those admitted, median length of stay was 3.1 days (range2–10). Reason for admission included pain (43.8%), post-operative complications (18.8%) and urinary retention (18.8%). Patients requiring admission were significantly older (mean age 62 vs 49 years old), were more likely to be male (62.5% vs 37.5%) and had a significantly longer theatre time (1.46 vs 1.08 hours, p=0.0001). Conclusions Our short review has identified older and male patient are more likely to require an overnight admission. Improvement in pain management, theatre planning and streamlining along with optimal discharge planning may reduce the volume of patient requiring UA.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85752599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Rizkallah, Tarak Agrebi Moumni Chouari, Sarah Zhao, N. Yang, Stella Vig, Nikheel Patel, Akriti Nanda
Abstract Aims NHSE/I and the RCS England have advocated that the separation of elective and surgical care is fundamental in recovering surgical services. It is suggested that the separation is physical and many Trusts are transforming pathways into elective and emergency hospitals. Croydon Hospital (CHS) have created an alternative, with ‘a Hospital within a Hospital’, separating these pathways within one estate, and considers whether this is a successful model for the future. Methods The day surgery unit on the ground floor was converted into an emergency centre with an ambulatory surgical hub, a hot clinic, clinical space, 4 emergency theatres and an USS room. The main theatre suite was converted into the Croydon Elective Centre (CEC) with a 12-bedded coronary catheter suite, a lift onto the second floor, 10 theatres, a 12 bedded children's day unit, Moorfields’ eye unit, a new canteen, an admissions unit as well as a 28-bedded elective ward with a new 4-bedded level 1.5 critical care unit. Results At the end of wave 1, 3,068 patients awaited treatment, an increase of 30.44% of baseline activity with theatre activity at 28% of normal activity. Activity resumed to 100% within 6 weeks of CEC go live. 2/9,606 patients were Covid-19 positive in the first year. During wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098 patients await treatment. Conclusion The implementation of a surgical hub has supported the treatment of patients as well as provided continuous training opportunities for surgical and anaesthetic trainees as well as the theatre team.
{"title":"SP2.1.7 The Croydon Elective Centre - Surgical Hub supporting patient care and surgical training","authors":"G. Rizkallah, Tarak Agrebi Moumni Chouari, Sarah Zhao, N. Yang, Stella Vig, Nikheel Patel, Akriti Nanda","doi":"10.1093/bjs/znac247.021","DOIUrl":"https://doi.org/10.1093/bjs/znac247.021","url":null,"abstract":"Abstract Aims NHSE/I and the RCS England have advocated that the separation of elective and surgical care is fundamental in recovering surgical services. It is suggested that the separation is physical and many Trusts are transforming pathways into elective and emergency hospitals. Croydon Hospital (CHS) have created an alternative, with ‘a Hospital within a Hospital’, separating these pathways within one estate, and considers whether this is a successful model for the future. Methods The day surgery unit on the ground floor was converted into an emergency centre with an ambulatory surgical hub, a hot clinic, clinical space, 4 emergency theatres and an USS room. The main theatre suite was converted into the Croydon Elective Centre (CEC) with a 12-bedded coronary catheter suite, a lift onto the second floor, 10 theatres, a 12 bedded children's day unit, Moorfields’ eye unit, a new canteen, an admissions unit as well as a 28-bedded elective ward with a new 4-bedded level 1.5 critical care unit. Results At the end of wave 1, 3,068 patients awaited treatment, an increase of 30.44% of baseline activity with theatre activity at 28% of normal activity. Activity resumed to 100% within 6 weeks of CEC go live. 2/9,606 patients were Covid-19 positive in the first year. During wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098 patients await treatment. Conclusion The implementation of a surgical hub has supported the treatment of patients as well as provided continuous training opportunities for surgical and anaesthetic trainees as well as the theatre team.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88447603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The COVID-19 pandemic has significantly revolutionised medical practice around the world. Healthcare resources had to be prioritise for the management of patients infected with the virus whilst routine and elective surgeries were postponed in order to free up hospital beds in anticipation for the influx of patients with COVID-19 requiring hospital admission. With the government announcing a national lockdown in March 2020, a striking reduction in the number of patients presenting to hospital was noted. Aim Our aim was to establish how the COVID-19 pandemic has impacted on the number and presentations of general surgical patients in a university hospital. Method: We conducted a retrospective study on general surgical patients who were reviewed by the surgical team at the University teaching hospital. Data was collected over two 7-weeks periods; between the 23rd March and 10th May 2020 (the first lockdown duration in the UK) and the corresponding 7-weeks in 2019 (that is between 25th March and 12th May 2019). Results The analysis of our data showed that there was a significant reduction in the number of surgical patients being admitted. 399 patients were admitted between 25th March and 12th May 2019 compared to only 245 patients during the lockdown period. The average admissions per day over the 7-weeks period dropped from 9 admissions per day in 2019 to 5 admission per day during national lockdown. Small bowel obstruction and pancreatitis remained common diagnoses in both 7-weeks periods, however diverticulitis was less common during lockdown.
{"title":"EP-511 The influence of the national lockdown during the COVID-19 pandemic on surgical presentations and admissions in a university hospital","authors":"V. Dhunnoo, I. Haq, O. Rutka","doi":"10.1093/bjs/znac245.124","DOIUrl":"https://doi.org/10.1093/bjs/znac245.124","url":null,"abstract":"Abstract Background The COVID-19 pandemic has significantly revolutionised medical practice around the world. Healthcare resources had to be prioritise for the management of patients infected with the virus whilst routine and elective surgeries were postponed in order to free up hospital beds in anticipation for the influx of patients with COVID-19 requiring hospital admission. With the government announcing a national lockdown in March 2020, a striking reduction in the number of patients presenting to hospital was noted. Aim Our aim was to establish how the COVID-19 pandemic has impacted on the number and presentations of general surgical patients in a university hospital. Method: We conducted a retrospective study on general surgical patients who were reviewed by the surgical team at the University teaching hospital. Data was collected over two 7-weeks periods; between the 23rd March and 10th May 2020 (the first lockdown duration in the UK) and the corresponding 7-weeks in 2019 (that is between 25th March and 12th May 2019). Results The analysis of our data showed that there was a significant reduction in the number of surgical patients being admitted. 399 patients were admitted between 25th March and 12th May 2019 compared to only 245 patients during the lockdown period. The average admissions per day over the 7-weeks period dropped from 9 admissions per day in 2019 to 5 admission per day during national lockdown. Small bowel obstruction and pancreatitis remained common diagnoses in both 7-weeks periods, however diverticulitis was less common during lockdown.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88325061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Caine, L. Wickstone, Charlotte Rogers, C. Macutkiewicz, Anthony Chan
Abstract Introduction The COVID-19 pandemic has significantly changed outpatient clinic services which now involve virtual (telephone/video) rather than face-to-face consultations. For both new clinic patients or follow-up patients after a recent emergency admission, these changes may impact on their perceptions and confidence in the outpatient service. The aim of this service provision audit is to ascertain both patient satisfaction and confidence in virtual consultations in our unit. Methods A retrospective evaluation of all General Surgery virtual clinic appointments between January and March 2021 was undertaken. Patients were contacted for feedback about their surgical consultation based on questions from the National Health Service Outpatient Department Survey (2011). Results In total, 151 patients were contacted. Overall satisfaction regarding telephone consultations was significantly higher when compared to survey results of face-to-face appointments in the pre-COVID era. The majority of patients were confident (51%) or confident to some extent (27%) of being listed for surgery without further examination. Only 8% of patients were not confident at the way surgery was explained and 10% were not confident of the risks of surgery. Finally, more than a third were not happy to be discharged from clinic following a telephone consultation. Conclusion Follow-up appointments are an integral part of the patient journey following an emergency admission. The COVID-19 recovery phase has necessitated a service reconfiguration towards virtual appointments. We show that patients were satisfied with virtual consultations, although further quality improvement should be undertaken to ensure outpatient discharge is satisfactory for all patients following an emergency admission.
{"title":"TU7.4 Service Evaluation Audit of Virtual Outpatient Clinics in the Post-COVID-19 era","authors":"Matthew Caine, L. Wickstone, Charlotte Rogers, C. Macutkiewicz, Anthony Chan","doi":"10.1093/bjs/znac248.066","DOIUrl":"https://doi.org/10.1093/bjs/znac248.066","url":null,"abstract":"Abstract Introduction The COVID-19 pandemic has significantly changed outpatient clinic services which now involve virtual (telephone/video) rather than face-to-face consultations. For both new clinic patients or follow-up patients after a recent emergency admission, these changes may impact on their perceptions and confidence in the outpatient service. The aim of this service provision audit is to ascertain both patient satisfaction and confidence in virtual consultations in our unit. Methods A retrospective evaluation of all General Surgery virtual clinic appointments between January and March 2021 was undertaken. Patients were contacted for feedback about their surgical consultation based on questions from the National Health Service Outpatient Department Survey (2011). Results In total, 151 patients were contacted. Overall satisfaction regarding telephone consultations was significantly higher when compared to survey results of face-to-face appointments in the pre-COVID era. The majority of patients were confident (51%) or confident to some extent (27%) of being listed for surgery without further examination. Only 8% of patients were not confident at the way surgery was explained and 10% were not confident of the risks of surgery. Finally, more than a third were not happy to be discharged from clinic following a telephone consultation. Conclusion Follow-up appointments are an integral part of the patient journey following an emergency admission. The COVID-19 recovery phase has necessitated a service reconfiguration towards virtual appointments. We show that patients were satisfied with virtual consultations, although further quality improvement should be undertaken to ensure outpatient discharge is satisfactory for all patients following an emergency admission.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85604232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Srushti Bhat, Nada Al Yasen, P. Perikleous, K. Lau
Abstract Aims The COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays. Methods An audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care. Results The implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained. Conclusion COVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.
{"title":"EP-488 Pre-operative electronic checklists as a systematic method to improve patient care","authors":"Srushti Bhat, Nada Al Yasen, P. Perikleous, K. Lau","doi":"10.1093/bjs/znac245.115","DOIUrl":"https://doi.org/10.1093/bjs/znac245.115","url":null,"abstract":"Abstract Aims The COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays. Methods An audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care. Results The implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained. Conclusion COVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83289929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Clements, S. Bezzaa, Gemma Graham, Emmanuel Tharmarajah, K. Jamal, T. Lewis
Abstract Aims The Covid-19 pandemic necessitated use of video consultations to provide continued patient care. It is not clear if video clinics are well received by patients, or if they are cost efficient. We evaluate the benefits of video consultation and review the impact on waiting times and cost implications to a trust. Methods 100 patients referred between January - December 2021 with gallstones were invited to complete a patient satisfaction questionnaire after initial clinic consultation. Patients were divided into three groups based on consultation type; face-to-face, telephone and video consultation (via the Attend Anywhere platform). Secondary outcome measures included time from referral to appointment, time to final outcome and cost implications. Results 93 patients responded; 33 video, 30 face-to-face and 30 telephone consultations. Of these patients 62% were female and 38% male with an average age of 51 (25–84). Average time from referral was 22 days in the video cohort, 22 in the telephone cohort and 32 for face-to-face appointments. Of the video cohort, 44% were booked for cholecystectomy from initial consultation and 56% sent for further investigation. The conversion rate from video to face-to-face consultation was zero. 50% of respondents stated face-to-face consultations as their preferred method of future consultation, 49% of patients opted for video and 1% preferred telephone consultation. 79% reported increased satisfaction due to convenience of consultation. Conclusion This study demonstrates video consultations decrease costs and waiting times. Patient satisfaction is comparable to in-person visit. Specific referral criteria and patient selection is essential to maximise the benefits of video consultations.
{"title":"TU7.8 Pay Per View: Cost and Satisfaction of Virtual Video Clinics","authors":"C. Clements, S. Bezzaa, Gemma Graham, Emmanuel Tharmarajah, K. Jamal, T. Lewis","doi":"10.1093/bjs/znac248.070","DOIUrl":"https://doi.org/10.1093/bjs/znac248.070","url":null,"abstract":"Abstract Aims The Covid-19 pandemic necessitated use of video consultations to provide continued patient care. It is not clear if video clinics are well received by patients, or if they are cost efficient. We evaluate the benefits of video consultation and review the impact on waiting times and cost implications to a trust. Methods 100 patients referred between January - December 2021 with gallstones were invited to complete a patient satisfaction questionnaire after initial clinic consultation. Patients were divided into three groups based on consultation type; face-to-face, telephone and video consultation (via the Attend Anywhere platform). Secondary outcome measures included time from referral to appointment, time to final outcome and cost implications. Results 93 patients responded; 33 video, 30 face-to-face and 30 telephone consultations. Of these patients 62% were female and 38% male with an average age of 51 (25–84). Average time from referral was 22 days in the video cohort, 22 in the telephone cohort and 32 for face-to-face appointments. Of the video cohort, 44% were booked for cholecystectomy from initial consultation and 56% sent for further investigation. The conversion rate from video to face-to-face consultation was zero. 50% of respondents stated face-to-face consultations as their preferred method of future consultation, 49% of patients opted for video and 1% preferred telephone consultation. 79% reported increased satisfaction due to convenience of consultation. Conclusion This study demonstrates video consultations decrease costs and waiting times. Patient satisfaction is comparable to in-person visit. Specific referral criteria and patient selection is essential to maximise the benefits of video consultations.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83801778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aims To determine the presentation and outcomes of cases of intestinal Ischemia amidst COVID -19 pandemic and to review latest guidelines in its management. Methods A case series analysis of 11 patients admitted and managed under Department of Surgery, over a duration of 17 months from September 2020 to January 2022. Results Out of the total of 11 cases of intestinal ischemia, 4 were COVID-19 positive, overall mortality was 54.5% and patients with COVID-19 were found to have 100% mortality. Mortality in conservatively managed patients was also 100%, Mortality in surgically managed patients was 55.5%. Preoperative acidosis, hypoxia and hypotension were found to be important determinants of outcome of the disease. Conclusion Occurrence of intestinal Ischemia in COVID - 19 patients is a life threatening complication which demands surgical management with significant mortality. Treatment of COVID - 19 and intestinal Ischemia should go simultaneously and in line with the latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to the COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia
{"title":"EP-566 A case series analysis of intestinal ischemia in COVID- 19 pandemic","authors":"D. B. M., K. Somasekhar","doi":"10.1093/bjs/znac245.132","DOIUrl":"https://doi.org/10.1093/bjs/znac245.132","url":null,"abstract":"Abstract Aims To determine the presentation and outcomes of cases of intestinal Ischemia amidst COVID -19 pandemic and to review latest guidelines in its management. Methods A case series analysis of 11 patients admitted and managed under Department of Surgery, over a duration of 17 months from September 2020 to January 2022. Results Out of the total of 11 cases of intestinal ischemia, 4 were COVID-19 positive, overall mortality was 54.5% and patients with COVID-19 were found to have 100% mortality. Mortality in conservatively managed patients was also 100%, Mortality in surgically managed patients was 55.5%. Preoperative acidosis, hypoxia and hypotension were found to be important determinants of outcome of the disease. Conclusion Occurrence of intestinal Ischemia in COVID - 19 patients is a life threatening complication which demands surgical management with significant mortality. Treatment of COVID - 19 and intestinal Ischemia should go simultaneously and in line with the latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to the COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89379813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesca Muscara, Jennifer Jebamani, Bogdan Ivanov
Abstract Aims Cholecystectomy is one of the most frequently performed operations in the United Kingdom. Following the spread of COVID19 infection, reduced operational capacity has led to lengthen the waiting time for cholecystectomy, which leads to significant readmission rate, growing financial burden and increased complexity of the surgical intervention. Our study aims to identify changes in gallbladder (GB) histopathological findings before and during COVID19 pandemic. Methods Data was collected retrospectively on 337 patients who underwent cholecystectomy between 01/2019–12/2019 (pre-COVID19) and 296 patients between 09/2020–10/2021 (during COVID19) at Princess Alexandra Hospital, including preoperative clinical-radiological, surgery waiting time, operation details, postoperative histology and complications. Statistical analysis performed using chi-square tests (p-value<0.001). Results A total of 2 (0.6%) female cases (average age 75.6) had gallbladder dysplasia (GD) and 1 of them had GB adenocarcinoma found pre-COVID19 versus 8 (2.7%) (7F:1M, average age 46.6) with GD and 5 (1.7%) (3F:2M, average age 72.6) with adenocarcinoma during pandemic. Other histopathological findings were 153 (45.4%) GB with chronic inflammation, 2 (0.5%) with necrosis or perforation pre-COVID19 versus 127 (42.9%) and 6 (2%) respectively during pandemic. The average surgery waiting time for patients with GD or adenocarcinoma was 135 days before COVID19 versus 224.21 (33–676) during pandemic. Conclusions GD is associated with increased cancer risk at GB and other biliary tract sites. Our data demonstrated a statistically significant increase of incidence of GD and adenocarcinoma (p-value<0.00089) in patients who underwent cholecystectomy during pandemic versus pre-COVID19. Further ongoing study is recommended to understand the correlation with prolonged surgery waiting time.
{"title":"TU3.7 Increased incidence of gallbladder dysplasia and cancer during COVID19 pandemic","authors":"Francesca Muscara, Jennifer Jebamani, Bogdan Ivanov","doi":"10.1093/bjs/znac248.031","DOIUrl":"https://doi.org/10.1093/bjs/znac248.031","url":null,"abstract":"Abstract Aims Cholecystectomy is one of the most frequently performed operations in the United Kingdom. Following the spread of COVID19 infection, reduced operational capacity has led to lengthen the waiting time for cholecystectomy, which leads to significant readmission rate, growing financial burden and increased complexity of the surgical intervention. Our study aims to identify changes in gallbladder (GB) histopathological findings before and during COVID19 pandemic. Methods Data was collected retrospectively on 337 patients who underwent cholecystectomy between 01/2019–12/2019 (pre-COVID19) and 296 patients between 09/2020–10/2021 (during COVID19) at Princess Alexandra Hospital, including preoperative clinical-radiological, surgery waiting time, operation details, postoperative histology and complications. Statistical analysis performed using chi-square tests (p-value<0.001). Results A total of 2 (0.6%) female cases (average age 75.6) had gallbladder dysplasia (GD) and 1 of them had GB adenocarcinoma found pre-COVID19 versus 8 (2.7%) (7F:1M, average age 46.6) with GD and 5 (1.7%) (3F:2M, average age 72.6) with adenocarcinoma during pandemic. Other histopathological findings were 153 (45.4%) GB with chronic inflammation, 2 (0.5%) with necrosis or perforation pre-COVID19 versus 127 (42.9%) and 6 (2%) respectively during pandemic. The average surgery waiting time for patients with GD or adenocarcinoma was 135 days before COVID19 versus 224.21 (33–676) during pandemic. Conclusions GD is associated with increased cancer risk at GB and other biliary tract sites. Our data demonstrated a statistically significant increase of incidence of GD and adenocarcinoma (p-value<0.00089) in patients who underwent cholecystectomy during pandemic versus pre-COVID19. Further ongoing study is recommended to understand the correlation with prolonged surgery waiting time.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"62 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90105309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Singhal, I. Omar, B. Madhok, C. Ludwig, A. Tahrani, K. Mahawar
Abstract Background It has been suggested that patients with a Body Mass Index (BMI) of >60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI<50 kg/m2), Group II (BMI 50–60 kg/m2), and Group III (BMI>60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results This study included 7084 patients (5197;73.4% females). The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively. Group I included 6024 (85%) patients, whereas Groups II and III included 905 (13%) and 155 (2%) patients, respectively. The 30-day mortality rate was higher in Group III (p=0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p=<0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of >70 kg/m2 had a 30-day mortality of 7.7% (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion The 30-day mortality rate was significantly higher in patients with BMI >60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.
{"title":"SPOD1 Effect of BMI on Safety of Bariatric Surgery during the COVID-19 pandemic, Procedure Choice, and Safety Protocols – an analysis from the GENEVA Study","authors":"R. Singhal, I. Omar, B. Madhok, C. Ludwig, A. Tahrani, K. Mahawar","doi":"10.1093/bjs/znac246.013","DOIUrl":"https://doi.org/10.1093/bjs/znac246.013","url":null,"abstract":"Abstract Background It has been suggested that patients with a Body Mass Index (BMI) of >60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI<50 kg/m2), Group II (BMI 50–60 kg/m2), and Group III (BMI>60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results This study included 7084 patients (5197;73.4% females). The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively. Group I included 6024 (85%) patients, whereas Groups II and III included 905 (13%) and 155 (2%) patients, respectively. The 30-day mortality rate was higher in Group III (p=0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p=<0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of >70 kg/m2 had a 30-day mortality of 7.7% (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion The 30-day mortality rate was significantly higher in patients with BMI >60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77251698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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