Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life
Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life
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DOI：
10.1186/s13017-020-00314-3
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发表时间：
2020-05-24
影响因子：
8
通讯作者：
Catarci, Marco
中科院分区：
文献类型：
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作者：
Patriti, Alberto;Baiocchi, Gian Luca;Catarci, Marco
背景：新冠肺炎疫情于2020年2月下旬在意大利迅速蔓延。几乎所有的外科服务都进行了重组，目的是保持适当的治疗途径，特别是在外科紧急情况下。在起草临床建议时，了解处理紧急手术的外科医生在现实生活中如何应对疫情可能是有用的。方法邀请来自意大利多个地区的外科医生进行在线调查，以了解他们目前对新冠肺炎阳性患者患有紧急外科疾病的行为。一份包含37个项目的问卷中包括了关于病人治疗和限制流行病传播的机构规则和个人方法的问题。结果回收急诊外科机构调查问卷71份。从地理角度来看，参与研究的外科医生被平均细分，公立(97.2%)和非学术(91.5%)中心的比例很大。在80.3%的病例中，医院治疗了新冠肺炎患者；在691%的中心，需要改变工作计划，33.8%的团队几乎有一名外科医生感染或正在进行预防性隔离。绝大多数外科医生只对紧急病例进行手术(73.9%)，但干预措施的数量明显下降。高达40%的非创伤性腹部急诊病例有不寻常的延迟治疗。在新冠肺炎介入治疗中，69.6%的患者采用了腹腔镜手术。对于世卫组织的建议，保护医护人员免受新冠肺炎感染和识别无症状感染外科医生的策略分别在70.4%和90.2%的中心是次优的。只有12.7%的中心在所有手术中采用了先进的手术室工作人员个人防护装备。讨论这项调查证实，新冠肺炎的爆发正在极大地改变意大利紧急手术中心的做法。尽管数量有所减少，但由于诊断延误，紧急病例平均更具挑战性。国际科学学会的建议经常没有得到遵守，这些建议涉及使用腹腔镜术、手术室是否提供个人防护设备以及对无症状的医生和患者进行测试。有必要进一步评估这些态度的短期结果，以调整国际建议。
Background COVID-19 pandemic has rapidly spread in Italy in late February 2020. Almost all surgical services have been reorganized, with the aim of maintaining an adequate therapeutic path, especially for surgical emergencies. The knowledge of how surgeons dealing with emergency surgery have reacted to the epidemic in the real life can be useful while drafting clinical recommendations. Methods Surgeons from multiple Italian regions were invited answering to an online survey in order to make a snapshot of their current behaviors towards COVID-19-positive patients bearing urgent surgical diseases. Questions about institutional rules and personal approach for patient treatment and to limit epidemic spread were included in a 37-item questionnaire. Results Seventy-one questionnaires from institutions dealing with emergency surgery were accepted. Participating surgeons were equally subdivided from a geographical point of view, with a large proportion of public (97.2%) and non-academical (91.5%) centers. In 80.3% of cases, the hospitals treated COVID-19 patients; in 69.1% of centers, a change in work plan was necessary, and 33.8% of teams had almost a surgeon infected or in preventive quarantine. The vast majority of surgeons operated only on urgent cases (73.9%), but the number of interventions significantly dropped. Up to 40% of non-traumatic abdominal emergency cases had an unusual delayed treatment. The laparoscopic approach was used in 69.6% of interventions on COVID-19 patients. Strategies to protect health care workers against COVID-19 infection and to identify asymptomatic infected surgeons were suboptimal with respect to the WHO recommendations in 70.4% and 90.2% of centers, respectively. Advanced personal protective equipment for operating room workers was adopted for all surgeries in only 12.7% of centers. Discussion This survey confirms that the COVID-19 outbreak is dramatically changing the practice of emergency surgery centers in Italy. Despite the reduction in number, urgent cases were on average more challenging owing to diagnostic delay. Recommendations from the International Scientific Societies are frequently not complied concerning the use of laparoscopic approach, the availability of personal protective equipment in the operating rooms, and the testing of both asymptomatic physicians and patients scheduled for surgery. A further evaluation of the short-term results of these attitudes is warranted to modulate international recommendations.