A Structured Approach for Safely Reintroducing Bariatric Surgery in a COVID-19 Environment.
Humans; Male; Adult; Female; Risk Factors; Cohort Studies; Middle Aged; Clinical Protocols; Patient Selection; Bariatric Surgery; Pneumonia; Safety; Complications; COVID-19; Bariatric surgery; Betacoronavirus; Coronavirus; Coronavirus Infections/epidemiology/prevention & control; Infection Control/organization & administration; Obesity Morbid/complications/surgery; Pandemics/prevention & control; Pneumonia Viral/epidemiology/prevention & control
Due to the profound effect of novel coronavirus disease 2019 (COVID-19) on healthcare systems, surgical programs across the country have paused surgical operations and have been utilizing virtual visits to help maintain public safety. For those who treat obesity, the importance of bariatric surgery has never been more clear. Emerging studies continue to identify obesity and several other obesity-related comorbid conditions as major risk factors for a more severe COVID-19 disease course. However, this also suggests that patients seeking bariatric surgery are inherently at risk of suffering severe complications if they were to contract COVID-19 in the perioperative period. The aim of this protocol is to utilize careful analysis of existing risk stratification for bariatric patients, novel COVID-19-related data, and consensus opinion from multiple academic bariatric centers within our organization to help guide the reanimation of our programs when appropriate and to use this template to prospectively study this risk-stratified population in real time. The core principles of this protocol can be applied to any surgical specialty.
Daigle CR; Augustin T; Wilson R; Schulz K; Fathalizadeh A; Laktash A; Bauman M; Bencsath KP; Cha W; Rodriguez J; Aminian A
Obesity Surgery
2020
2020-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1007/s11695-020-04733-8" target="_blank" rel="noreferrer noopener">10.1007/s11695-020-04733-8</a>
Delaying cancer cases in urology during COVID-19: review of the literature.
Urologic Surgical Procedures; Coronavirus; COVID-19; Urologic Neoplasm
PURPOSE: Coronavirus Disease 2019 (COVID-19) is a global pandemic affecting hospital systems and the availability of resources for surgical procedures. Our aim is to provide guidance for urologists to help prioritize urologic cancer surgeries. MATERIAL AND METHODS: We reviewed published literature on bladder cancer, upper tract urothelial carcinoma (UTUC), penile cancer, testis cancer, prostate cancer, renal cancer, and adrenal cancer. RESULTS: For muscle invasive bladder cancer (MIBC), delays should be less than roughly 10 weeks and neoadjuvant chemotherapy should be considered. For non-MIBC, patients should be counseled appropriately based on risk and intravesical therapies can continue. UTUC should also be treated with minimal delays for high risk patients, especially with ureteral tumors. Surgery for T1 renal cancers when indicated can be delayed until adequate resources are available. Patients with T2 renal cancer should be considered for early surgery if there are unfavorable pre-operative characteristics. Higher stage renal tumors should be considered for early surgery. Early multi-disciplinary approach is recommended for metastatic renal cancers. High risk prostate cancer may need preferential treatment and consideration of neoadjuvant hormonal therapy. Penile cancer can have worse sexual or oncologic outcome with prolonged surgical delay. Likewise, adrenal cancer is aggressive and needs early surgical treatment. Testicular cancer should be treated in a timely manner with surgery or chemotherapy, as indicated. CONCLUSIONS: This review should further assist urologists in recognizing patients with potentially aggressive tumor biology that warrant early treatment.
Tachibana I; Ferguson EL; Mahenthiran A; Natarajan JP; Masterson TA; Bahler CD; Sundaram CP
The Journal of Urology
2020
2020-07-17
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/JU.0000000000001288" target="_blank" rel="noreferrer noopener">10.1097/JU.0000000000001288</a>
The impact of covid-19 on suicidal ideation and alcohol presentations to emergency departments in a large healthcare system.
Behavioral health; Coronavirus; COVID-19; Emergency departments; Suicidal ideation
Smalley CM; Malone DA; Meldon SW; Borden BL; Simon EL; Muir MR; Fertel BS
The American Journal of Emergency Medicine
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ajem.2020.05.093" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2020.05.093</a>
Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations.
acute respiratory syndrome; anaesthesia; cesarean delivery; coronavirus; COVID-19; COVID-19; dispersion; exhaled air; hypotension; management
Coronavirus disease 2019 (COVID-19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID-19 contamination in operating rooms and significantly exposes the healthcare teams to COVID-19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol-generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID-19 pandemic are limited. The goal of this review is to provide up-to-date, evidence-based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID-19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post-anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.
Uppal V; Sondekoppam R V; Landau R; El-Boghdadly K; Narouze S; Kalagara H K P
Anaesthesia
2020
2020-04-28
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/anae.15105" target="_blank" rel="noreferrer noopener">10.1111/anae.15105</a>