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  1. Article ; Online: Emergency department utilization by children with general surgical conditions during the COVID-19 pandemic.

    Balvardi, S / Fiore, J / Feldman, L S / Emil, S / Poenaru, D

    The British journal of surgery

    2021  Volume 108, Issue 3, Page(s) e105–e106

    MeSH term(s) Adolescent ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/psychology ; Child ; Child, Preschool ; Emergency Service, Hospital/trends ; Facilities and Services Utilization/trends ; Follow-Up Studies ; Hospitals, Pediatric/trends ; Humans ; Infant ; Infant, Newborn ; Outcome Assessment, Health Care ; Pandemics ; Patient Acceptance of Health Care/statistics & numerical data ; Quebec/epidemiology ; Surgical Procedures, Operative/trends
    Language English
    Publishing date 2021-04-01
    Publishing country England
    Document type Letter
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znaa096
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  2. Article ; Online: Response to the Comment on "Impact of Facilitation of Early Mobilization on Postoperative Pulmonary Outcomes After Colorectal Surgery": A Randomized Controlled Trial.

    Balvardi, Saba / Feldman, Liane S / Fiore, Julio F

    Annals of surgery

    2021  Volume 274, Issue 6, Page(s) e940

    MeSH term(s) Analgesia, Patient-Controlled ; Colorectal Surgery/adverse effects ; Digestive System Surgical Procedures ; Early Ambulation ; Humans ; Postoperative Period
    Language English
    Publishing date 2021-10-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005055
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  3. Article ; Online: The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures.

    Balvardi, Saba / Alhashemi, Mohsen / Cipolla, Josie / Lee, Lawrence / Fiore, Julio F / Feldman, Liane S

    Surgical endoscopy

    2022  Volume 36, Issue 9, Page(s) 6712–6718

    Abstract: Introduction: During the COVID-19 pandemic, the redeployment of operating room (OR) staff resulted in a significant ramp-down of elective surgery. To mitigate the negative effects of the pandemic on surgical education, this study was planned to estimate ...

    Abstract Introduction: During the COVID-19 pandemic, the redeployment of operating room (OR) staff resulted in a significant ramp-down of elective surgery. To mitigate the negative effects of the pandemic on surgical education, this study was planned to estimate the impact of the first wave of the pandemic on the participation of general surgery residency and fellowship trainees in operative procedures.
    Methods: This study is a retrospective review of all adult general surgery procedures performed at 3 sites of an academic health care network. Cases performed during the first wave of the pandemic (March-June 2020) were compared to the same period of the previous year pre-pandemic (March-June 2019). Trainees were categorized as junior (Post-Graduate-Year [PGY] 1-2), senior (PGY3-5), or fellows (PGY6-7). Operating exposure was defined as (1) the total number of cases attended by at least one trainee and (2) total time spent in the OR by all trainees (hours). The impact of the pandemic was estimated as percentage of baseline (2019).
    Results: During the first wave of the pandemic, a total of 914 cases were performed, compared to 1328 in the pre-pandemic period (69%). Junior trainees were more affected than senior trainees with reductions in both case volume (68% versus 78% of baseline attendance) and time (68% versus 77% of baseline operating time). Minimally invasive surgery fellows were most severely affected trainees and colorectal fellows were least affected (14% and 75% of baseline cases, respectively). Participation in emergency surgery cases and surgical oncology cases was relatively preserved (87% and 105% of baseline, respectively).
    Conclusions: The first wave of the COVID-19 pandemic reduced operative exposure for general surgery trainees by approximately 30%. Procedure-specific patterns reflected institutional policies for prioritizing cancer operations and emergency surgeries. These findings may inform the design of remediation activities to mitigate the impact of the pandemic on surgical training.
    MeSH term(s) Adult ; COVID-19/epidemiology ; Clinical Competence ; Fellowships and Scholarships ; General Surgery/education ; Humans ; Internship and Residency ; Pandemics
    Language English
    Publishing date 2022-01-03
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-021-08944-7
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  4. Article ; Online: The association between video-based assessment of intraoperative technical performance and patient outcomes: a systematic review.

    Balvardi, Saba / Kammili, Anitha / Hanson, Melissa / Mueller, Carmen / Vassiliou, Melina / Lee, Lawrence / Schwartzman, Kevin / Fiore, Julio F / Feldman, Liane S

    Surgical endoscopy

    2022  Volume 36, Issue 11, Page(s) 7938–7948

    Abstract: Background: Efforts to improve surgical safety and outcomes have traditionally placed little emphasis on intraoperative performance, partly due to difficulties in measurement. Video-based assessment (VBA) provides an opportunity for blinded and unbiased ...

    Abstract Background: Efforts to improve surgical safety and outcomes have traditionally placed little emphasis on intraoperative performance, partly due to difficulties in measurement. Video-based assessment (VBA) provides an opportunity for blinded and unbiased appraisal of surgeon performance. Therefore, we aimed to systematically review the existing literature on the association between intraoperative technical performance, measured using VBA, and patient outcomes.
    Methods: Major databases (Medline, Embase, Cochrane Database, and Web of Science) were systematically searched for studies assessing the association of intraoperative technical performance measured by tools supported by validity evidence with short-term (≤ 30 days) and/or long-term postoperative outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Results were appraised descriptively as study heterogeneity precluded meta-analysis.
    Results: A total of 11 observational studies were identified involving 8 different procedures in foregut/bariatric (n = 4), colorectal (n = 4), urologic (n = 2), and hepatobiliary surgery (n = 1). The number of surgeons assessed ranged from 1 to 34; patient sample size ranged from 47 to 10,242. High risk of bias was present in 5 of 8 studies assessing short-term outcomes and 2 of 6 studies assessing long-term outcomes. Short-term outcomes were reported in 8 studies (i.e., morbidity, mortality, and readmission), while 6 reported long-term outcomes (i.e., cancer outcomes, weight loss, and urinary continence). Better intraoperative performance was associated with fewer postoperative complications (6 of 7 studies), reoperations (3 of 4 studies), and readmissions (1 of 4 studies). Long-term outcomes were less commonly investigated, with mixed results.
    Conclusion: Current evidence supports an association between superior intraoperative technical performance measured using surgical videos and improved short-term postoperative outcomes. Intraoperative performance analysis using video-based assessment represents a promising approach to surgical quality-improvement.
    MeSH term(s) Humans ; Postoperative Complications/etiology ; Surgeons ; Weight Loss
    Language English
    Publishing date 2022-05-12
    Publishing country Germany
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09296-6
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  5. Article ; Online: Construct validity and responsiveness of the Duke Activity Status Index (DASI) as a measure of recovery after colorectal surgery.

    Pook, Makena / Elhaj, Hiba / El Kefraoui, Charbel / Balvardi, Saba / Pecorelli, Nicolo / Lee, Lawrence / Feldman, Liane S / Fiore, Julio F

    Surgical endoscopy

    2022  Volume 36, Issue 11, Page(s) 8490–8497

    Abstract: Background: Returning to preoperative levels of physical function is highly valued by patients recovering from surgery. The Duke Activity Status Index (DASI, a 12-item questionnaire) may be a simple yet robust tool to assess postoperative recovery of ... ...

    Abstract Background: Returning to preoperative levels of physical function is highly valued by patients recovering from surgery. The Duke Activity Status Index (DASI, a 12-item questionnaire) may be a simple yet robust tool to assess postoperative recovery of functional capacity. This study assessed construct validity and responsiveness of the DASI as a measure of recovery after colorectal surgery.
    Methods: Data from a trial on early mobilization after colorectal surgery were analyzed. Patients completed the DASI questionnaire preoperatively and at postoperative weeks (POW) 2 and 4. Construct validity was assessed by testing the primary a priori hypotheses that postoperative DASI scores (1) are higher in patients without vs with postoperative complications and (2) correlate with six-minute walk test distance (6MWD). Exploratory analyses assessed the association between DASI scores and (1) preoperative physical status [higher (ASA ≤ 2) vs lower (ASA > 2)], (2) stoma creation (no stoma vs stoma), (3) age [younger (≤ 75 years) vs older (> 75 years)], (4) time to readiness for discharge [shorter (≤ 4 days) vs longer (> 4 days)], and (5) surgical approach (laparoscopic vs open). Responsiveness was assessed by testing a priori hypotheses that DASI scores are higher (1) preoperatively vs at POW2 and (2) at POW4 vs POW2. Mean differences in DASI scores were obtained using linear regression. The association between DASI and 6MWD was assessed via Pearson correlation.
    Results: We analyzed data from 100 patients undergoing colorectal surgery (mean age 65; 57% male; 81% laparoscopic). Mean DASI scores were 47.9 ± 12.1 preoperatively, 22.4 ± 12.7 at POW2, and 33.2 ± 15.7 at POW4. The data supported our two primary construct validity hypotheses, as well as 3/5 exploratory hypotheses. Both responsiveness hypotheses were supported.
    Conclusions: Our findings support that the DASI questionnaire can be a useful tool to assess postoperative recovery of functional capacity in research and clinical practice.
    MeSH term(s) Humans ; Male ; Aged ; Female ; Colorectal Surgery ; Digestive System Surgical Procedures ; Surveys and Questionnaires ; Postoperative Period ; Laparoscopy
    Language English
    Publishing date 2022-02-25
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09145-6
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  6. Article ; Online: Effect of video-based self-reflection on intraoperative skills: A pilot randomized controlled trial.

    Balvardi, Saba / Kaneva, Pepa / Semsar-Kazerooni, Koorosh / Vassiliou, Melina / Al Mahroos, Mohammed / Mueller, Carmen / Fiore, Julio F / Schwartzman, Kevin / Feldman, Liane S

    Surgery

    2023  Volume 175, Issue 4, Page(s) 1021–1028

    Abstract: Background: The value of video-based self-assessment in enhancing surgical skills is uncertain. This study investigates the feasibility and estimates sample size for a full-scale randomized controlled trial to evaluate the effectiveness of video-based ... ...

    Abstract Background: The value of video-based self-assessment in enhancing surgical skills is uncertain. This study investigates the feasibility and estimates sample size for a full-scale randomized controlled trial to evaluate the effectiveness of video-based self-assessment to improve surgical performance of laparoscopic cholecystectomy in trainees.
    Methods: This parallel pilot randomized controlled trial included general surgery trainees performing supervised laparoscopic cholecystectomy randomized 1:1 to control (traditional intraoperative teaching) or intervention group (traditional teaching plus video-based self-assessment). Operative performance was measured by the attending surgeon blinded to group assignment at the time of surgery using standardized assessment tools (Global Operative Assessment of Laparoscopic Skills and Operative Performance Rating System). The intervention group had access to their video recordings on a web-based platform for review and self-assessment using the same instruments. The primary outcome for the estimation of sample size was the difference in faculty-assessed final operative performance (third submitted case). Feasibility criteria included >85% participation, >85% adherence to case submission and >85% completion of self-assessment.
    Results: Of 37 eligible trainees approached, 32 consented and were randomized (86%). There were 16 in the intervention group, 15 in the control group (55% male, 55% junior trainees), and 1 was excluded for protocol violation. Twenty-four (75%) of participants submitted 3 cases. Thirteen trainees (81%) accessed the platform and completed 26 (63.2%) case self-assessments. Fifty-five trainees per arm will be needed to power a full-scale laparoscopic cholecystectomy with Global Operative Assessment of Laparoscopic Skills and 130 trainees per arm with Operative Performance Rating System as the assessment tool.
    Conclusion: This pilot study contributes important data to inform the design of an adequately powered randomized controlled trial of video-based self-assessment to improve trainee performance of laparoscopic cholecystectomy. Although a priori trial feasibility criteria were not achieved, automated video capture and storage could significantly improve adherence in future trials.
    MeSH term(s) Humans ; Male ; Female ; Pilot Projects ; Laparoscopy/education ; Cholecystectomy, Laparoscopic/education ; Video Recording ; Surgeons ; Clinical Competence ; Internship and Residency
    Language English
    Publishing date 2023-12-27
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2023.11.028
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  7. Article ; Online: Systematic review of grading systems for adverse surgical outcomes.

    Balvardi, Saba / St-Louis, Etienne / Yousef, Yasmine / Toobaie, Asra / Guadagno, Elena / Baird, Robert / Poenaru, Dan

    Canadian journal of surgery. Journal canadien de chirurgie

    2021  Volume 64, Issue 2, Page(s) E196–E204

    Abstract: Background: Grading scales for adverse surgical outcomes have been poorly characterized to date. The primary aim of this study was to conduct a systematic review to enumerate the various frameworks for grading adverse postoperative outcomes; our ... ...

    Abstract Background: Grading scales for adverse surgical outcomes have been poorly characterized to date. The primary aim of this study was to conduct a systematic review to enumerate the various frameworks for grading adverse postoperative outcomes; our secondary objective was to outline the properties of each grading system, identifying its strengths and weaknesses.
    Methods: We searched 9 databases (Africa Wide Information, Biosis, Cochrane, Embase, Global Health, LILACs, Medline, PubMed and Web of Science) from 1992 (the year the Clavien-Dindo classification system was developed) until Mar. 2, 2017, for studies that aimed to develop or improve on an already existing generalizable system for grading adverse postoperative outcomes. Study selection was duplicated as per PRISMA recommendations. Procedure-specific grading systems were excluded. We assessed the framework, strengths and weaknesses of the systems qualitatively.
    Results: We identified 9 studies on 8 adverse outcome grading systems with frameworks generalizable to any surgical procedure. Most systems have not been widely incorporated in the literature. Seven of the 8 systems were produced without including patients' perspectives. Four allowed the derivation of a composite morbidity score, which had limited tangible significance for patients.
    Conclusion: Although each instrument identified offered its own advantages, none satisfied the need for a patient-centred tool capable of generating a composite score of all possible postoperative adverse outcomes (complications, sequelae and failure) that enables comparison of noninterventional and surgical management of disease. There is a need for development of a more comprehensive, patient-centred grading system for adverse postoperative outcomes.
    MeSH term(s) Humans ; Postoperative Complications/classification ; Severity of Illness Index
    Language English
    Publishing date 2021-03-26
    Publishing country Canada
    Document type Journal Article ; Systematic Review
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.016919
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    Zs.A 221: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  8. Article ; Online: S110-Opioid-free analgesia after outpatient general surgery: A qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial.

    Do, Uyen / Pook, Makena / Najafi, Tahereh / Rajabiyazdi, Fateme / El-Kefraoui, Charbel / Balvardi, Saba / Barone, Natasha / Elhaj, Hiba / Nguyen-Powanda, Philip / Lee, Lawrence / Baldini, Gabriele / Feldman, Liane S / Fiore, Julio F

    Surgical endoscopy

    2022  Volume 37, Issue 3, Page(s) 2269–2280

    Abstract: Background: Opioid-free analgesia (OFA) may mitigate opioid-related harms after outpatient general surgery; however, the comparative effectiveness of this approach should be assessed in robust randomized controlled trials (RCTs). Undertaking an RCT on ... ...

    Abstract Background: Opioid-free analgesia (OFA) may mitigate opioid-related harms after outpatient general surgery; however, the comparative effectiveness of this approach should be assessed in robust randomized controlled trials (RCTs). Undertaking an RCT on OFA raises important practical concerns, including surgeon and patient hesitation regarding pain management without opioids. We conducted a qualitative study to explore patients' and clinicians' perspectives and experiences with a pilot trial focused on OFA after outpatient general surgery.
    Methods: Patients undergoing outpatient abdominal and breast procedures were randomized to receive post-discharge opioid analgesia (OA) or OFA. Semi-structured interviews with patients and clinicians involved in the trial were conducted to elicit personal perspectives and experiences. Purposive sampling for maximum variation was used to recruit participants with diverse characteristics. Transcribed interviews were assessed using inductive thematic analysis.
    Results: Ten patients (5 abdominal, 5 breast) and 10 clinicians (6 surgeons, 2 anesthesiologists, 2 nurses) were interviewed. Five major themes emerged: readiness for trial engagement, pre-trial thoughts about the interventions, postoperative pain experiences, intervention acceptability, and trial refinement. Most patients were open to OFA. Clinicians expressed willingness to prescribe OFA, particularly after less invasive procedures and when using peripheral nerve blocks (PNBs). Concerns were raised regarding the adequacy of pain control and side effects of non-opioid drugs (e.g., NSAID-induced bleeding, kidney injury). Overall, participants were enthusiastic about the trial and recognized its relevance; clinicians praised the study design and organization; and patients valued the use of electronic questionnaires. Suggestions for improvements included preventing potential bias arising from the use of PNBs (i.e., via standardization or stratification) and reducing patient burden (i.e., decreasing postoperative questionnaires).
    Conclusion: Patients and clinicians who participated in a pilot RCT generally accept the clinical equipoise between OA versus OFA after outpatient general surgery and recognize the need for methodologically robust trials to inform evidence-based analgesia prescribing.
    MeSH term(s) Humans ; Analgesics, Opioid/therapeutic use ; Outpatients ; Pilot Projects ; Pain Management/methods ; Analgesia/methods ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Randomized Controlled Trials as Topic
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-08-02
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09472-8
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  9. Article ; Online: Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy.

    Balvardi, Saba / Semsar-Kazerooni, Koorosh / Kaneva, Pepa / Mueller, Carmen / Vassiliou, Melina / Al Mahroos, Mohammed / Fiore, Julio F / Schwartzman, Kevin / Feldman, Liane S

    Surgical endoscopy

    2022  Volume 37, Issue 3, Page(s) 2281–2289

    Abstract: Introduction: Self-review of recorded surgical procedures offers new opportunities for trainees to extend technical learning outside the operating-room. Valid tools for self-assessment are required prior to evaluating the effectiveness of video-review ... ...

    Abstract Introduction: Self-review of recorded surgical procedures offers new opportunities for trainees to extend technical learning outside the operating-room. Valid tools for self-assessment are required prior to evaluating the effectiveness of video-review in enhancing technical learning. Therefore, we aimed to contribute evidence regarding the validity of intraoperative performance assessment tools for video-based self-assessment by general surgery trainees when performing laparoscopic cholecystectomies.
    Methods and procedures: Using a web-based platform, general surgery trainees in a university-based residency program submitted recorded laparoscopic cholecystectomy procedures where they acted as the supervised primary surgeon. Attending surgeons measured operative performance at the time of surgery using general and procedure-specific assessment tools [Global Operative Assessment of Laparoscopic Skills (GOALS) and Operative Performance Rating System (OPRS), respectively] and entrustability level (O-SCORE). Trainees self-evaluated their performance from video-review using the same instruments. The validity of GOALS and OPRS for trainee self-assessment was investigated by testing the hypotheses that self-assessment scores correlate with (H1) expert assessment scores, (H2) O-SCORE, and (H3) procedure time and that (H4) self-assessment based on these instruments differentiates junior [postgraduate year (PGY) 1-3] and senior trainees (PGY 4-5), as well as (H5)simple [Visual Analogue Scale (VAS) ≤ 4] versus complex cases (VAS > 4). All hypotheses were based on previous literature, defined a priori, and were tested according to the COSMIN consensus on measurement properties.
    Results: A total of 35 videos were submitted (45% female and 45% senior trainees) and self-assessed. Our data supported 2 out of 5 hypotheses (H1 and H4) for GOALS and 3 out of 5 hypotheses (H1, H4 and H5) for OPRS, for trainee self-assessment.
    Conclusions: OPRS, a procedure-specific assessment tool, was better able to differentiate between groups expected to have different levels of intraoperative performance, compared to GOALS, a general assessment tool. Given the interest in video-based learning, there is a need to further develop valid procedure-specific tools to support video-based self-assessment by trainees in a range of procedures.
    MeSH term(s) Humans ; Female ; Male ; Cholecystectomy, Laparoscopic ; Self-Assessment ; Clinical Competence ; Internship and Residency ; Education, Medical, Graduate ; Laparoscopy
    Language English
    Publishing date 2022-08-03
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09466-6
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  10. Article ; Online: Impact of the Covid-19 pandemic on rates of emergency department utilization and hospital admission due to general surgery conditions.

    Balvardi, Saba / Cipolla, Josie / Touma, Nawar / Vallipuram, Tharaniya / Barone, Natasha / Sivarajan, Reginold / Kaneva, Pepa / Demyttenaere, Sebastian / Boutros, Marylise / Lee, Lawrence / Feldman, Liane S / Fiore, Julio F

    Surgical endoscopy

    2022  Volume 36, Issue 9, Page(s) 6751–6759

    Abstract: Background: Recent literature reports a decrease in healthcare-seeking behaviours by adults during the Covid-19 pandemic. Given that emergency general surgery (GS) conditions are often associated with high morbidity and mortality if left untreated, the ... ...

    Abstract Background: Recent literature reports a decrease in healthcare-seeking behaviours by adults during the Covid-19 pandemic. Given that emergency general surgery (GS) conditions are often associated with high morbidity and mortality if left untreated, the objective of this study was to describe and quantify the impact of the Covid-19 pandemic on rates of emergency department (ED) utilization and hospital admission due to GS conditions.
    Methods: This cohort study involved the analysis of an institutional database and retrospective chart review. We identified adult patients presenting to the ED in a network of three teaching hospitals in Montreal, Canada during the first wave of the Covid-19 pandemic (March13-May13, 2020) and a control pre-pandemic period (March13-May13, 2019). Patients with GS conditions were included in the analysis. ED utilization rates, admission rates and 30-day outcomes were compared between the two periods using multivariate regression analysis.
    Results: During the pandemic period, 258 patients presented to ED with a GS diagnosis compared to 351 patients pre-pandemically (adjusted rate ratio (aRR) 0.75; p < 0.001). Rate of hospital admission during the pandemic was also significantly lower (aRR = 0.77, p < 0.001). Patients had a significantly shorter ED stay during the pandemic (adjusted mean difference 5.0 h; p < 0.001). Rates of operative management during the pandemic were preserved compared to the pre-pandemic period. There were no differences in 30-day complications (adjusted odds ratio (aOR) 1.46; p = 0.07), ED revisits (aOR 1.10; p = 0.66) and (re)admissions (aOR 1.42; p = 0.22) between the two periods.
    Conclusion: There was a decrease in rates of ED utilization and hospital admissions due to GS conditions during the first wave of the Covid -19 pandemic; however, rates of operative management, complications and healthcare reutilization were unchanged. Although our findings are not generalizable to patients who did not seek healthcare, it was possible to successfully uphold institutional standards of care once patients presented to the ED.
    MeSH term(s) Adult ; COVID-19/epidemiology ; Cohort Studies ; Emergency Service, Hospital ; Hospitals ; Humans ; Pandemics ; Retrospective Studies
    Language English
    Publishing date 2022-01-03
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-021-08956-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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