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Abstract	Introduction: There is wide variation in the management of simple subcutaneous abscesses in the UK and no national guidelines describing best practice. During the SARS-CoV-2 pandemic, regional or local anaesthesia (LA) use was recommended instead of general anaesthesia. This study aimed to assess the effect of anaesthetic use on outcomes following incision and drainage (I&D) of simple subcutaneous abscesses. Methods: Two cohorts of patients undergoing abscess incision and drainage at St. James' University Hospital in Leeds were identified retrospectively over a 14-week period before (P1) and after (P2) the introduction of the COVID-19 anaesthetic guidelines. The number of follow-up appointments for repacking and representation to healthcare services 30 days after I&D were used as surrogate endpoints for wound healing. Results: A total of 133 patients were included ( Conclusions: Drainage of simple subcutaneous abscess under 5cm in diameter is safe under LA, with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient-reported outcomes, including pain management, cosmesis and the cost and sustainability implications of a change in this common procedure.
MeSH term(s)	Humans ; Cohort Studies ; Retrospective Studies ; Abscess/surgery ; COVID-19 ; SARS-CoV-2 ; Skin Diseases/surgery ; Drainage/methods ; Wound Healing ; Anesthetics
Chemical Substances	Anesthetics
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2021.0362
Database	MEDical Literature Analysis and Retrieval System OnLINE

Article ; Online: Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection

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Gomez Diaz C.J. / Garcia Galocha J.L. / de Gheldere C.A. / Ataide Gomes G.M. / Beltran de Heredia J. / Blazer III D.G. / Nugent III W.C. / Ali karar A.A. / Borja De Lacy F. / Blas Laina J.L. / Shane Lester M.J. / Liyanage A.S.D. / Al Maadany F.S. / De Marchi J.A. / Ramos-De la Medina A. / Mithany R.H.M. / Sanchez del Pueblo C. / van Ramshorst G.H. / De Salas M.M. / De Souza A.C. / Dolores Del Toro M. / Archer J.E. / Odeh A. / Erridge S. / Salem H.K. / Jones G.P. / Gardner A. / Tripathi S.S. / Gregg A. / Jeganathan R. / Siddique M.H. / Lombardi C.P. / Martin B. / Leo C.A. / Dass D. / Di Franco G. / Jiao L.R. / Mari G.M. / Capitan-Morales L.-C. / Connelly T.M. / Alanbuki A. / De Virgilio A. / Schilling C. / San Miguel Mendez C. / Kulkarni G. / Nizami K. / Walsh S. / Dean H. / Ruiz-Marin M. / Houston R. / Trompetto M. / Chrastek D. / Kouritas V. / Cannoletta M. / Rosato F. / Kaushal M.V. / Costa P.M. / Elkadi H.H. / Johnstone J.R. / Irvine E. / Alvarez M.R. / Corbellini C. / Venkatesan G.S. / Mateo-Sierra O. / Martinez-Perez C. / Serrano Gonzalez J. / Hernandez Bartolome M.A. / Diaz Perez D. / Gutierrez Samaniego M. / Galindo Jara P. / Sharma N. / Smart N.J. / Keller D.S.

an international cohort study

2020

Abstract: Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and ... ...

Abstract	Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Keywords	Adult ; Aged ; Betacoronavirus ; Coronavirus Infections ; Elective Surgical Procedures ; Emergency Medical Services ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia ; Viral ; Postoperative Complications ; Respiratory Tract Diseases ; Retrospective Studies ; Surgical Procedures ; Operative ; Young Adult ; covid19
Subject code	610 ; 616
Language	English
Publishing country	it
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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