Dataset Information

Managing surgical patients with a COVID-19 infection in the operating room: An experience from Indonesia.

ABSTRACT:

Background

The Coronavirus and the COVID-19 pandemic in 2020 have significantly impacted hospital care, including surgery practice. Hospitals must balance patient care, staff safety, resource availability, and medical ethics. Differences in community infection trends, national policies, availability of resources and technology, plus local circumstances may make uniform management impossible globally. This paper described the practical workflow of emergency COVID-19 surgery in a tertiary referral national hospital in Indonesia.

Method

This study focused on the process of preparation for COVID-19 surgery from March 2020-March 2021. We also described the available facilities in terms of equipment and human resources.

Results

Steps of COVID-19 surgery preparations were described, such as the setup of general and infectious triage in the emergency department, development of preoperative screening protocol for COVID-19, designation of a specialized COVID-19 operating room and surgical staff, changes in preoperative surgery and anesthesia workflow, development of checklists and postoperative monitoring on staff health.

Conclusions

Changes in the workflow are essential during the pandemic for safe surgery. These changes require a multidisciplinary approach, communication, and a continued willingness to adapt. We recommend local adaptation of our general workflow for emergency surgery during an epidemic or pandemic.

SUBMITTER: Giwangkancana G

PROVIDER: S-EPMC8268678 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and objective The impact of COVID-19 infection and the effect of COVID-19 vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccination in order to develop management guidelines relevant to our patients. Methods A total of 621 patients from our registry that included 297 MS and 324 non MS disorders (Aquaporin- 4 antibody positive [50], Myelin oligodendrocyte glycoprotein antibody positive [81], seronegative [162] and clinically isolated syndrome [31]) were contacted. COVID-19 infection and vaccination status were queried. Patients who self reported COVID-19 infection based on a positive RT PCR report were compared with non infected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. Results Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 81 patients had mild infection and remained quarantined at home. All 13 patients who needed hospitalization recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. In univariate analysis, presence of ≥1 comorbidity was significantly associated with COVID-19 infection in both MS (p value 0.01, OR-2.28, 95%CI- 1.18- 4.4) and non MS patients (p- 0.001, OR-4.4, 95% CI-1.88-10.24). In the latter, BMI ≥ 30 (p-0.04, OR-3.27, 95% CI- 0.98- 10.87) and EDSS score ≥ 3 (p-0.02, OR- 2.59,95% CI- 1.08- 6.23) were other significant associations. History of prior COVID-19 vaccination was associated with reduced frequency of COVID- 19 infection among MS (p- 0.001,OR- 0.24,95% CI- 0.13- 0.43) and non MS patients (p- 0.0001,OR-0.14, 95% CI- 0.058- 0.35). In multivariate analysis presence of comorbidities significantly increased and prior vaccination significantly reduced frequency of COVID-19 infection for both MS and related disorders. Concurrent disease modifying treatments showed a trend for association with infection. In the unvaccinated group, patients on disease modifying treatment were significantly at risk of infection, 81.5% unvaccinated and treated versus 18.5% who were unvaccinated and untreated (p- 0.0001, OR-10.1, 95% CI-0.56-2.11). Conclusion Frequency and severity of COVID-19 infection was low among our patient cohort. Higher rate of infection in the treated group was significantly seen among unvaccinated patients. Our preliminary results suggests that in LMIC's, where “off label therapies” with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and effective against severe COVID-19 infection.