18 research outputs found
Patterns of pediatric trauma in Ramadan: an observational study
Introduction Motor vehicle crashes are a major cause of death among the Saudi population. In Ramadan, the working hours and the road traffic rush hours differ from other months of the year; the pattern of trauma may also differ. We compared trauma in the pediatric age group in Ramadan with non-Ramadan months in terms of frequency, patterns, and severity.Methods We conducted a retrospective study, which included all pediatric trauma cases, from 2001 to 2009, who were registered in King Abdulaziz Medical City Trauma Registry. Trauma patterns were divided into two groups according to the date of occurrence: victims in Ramadan versus victims in non-Ramadan.Results A total of 3766 patients were included. The average number of trauma per month was 39.2 versus 44 for non-Ramadan and Ramadan months, respectively (P = 0.79). The mean patient age in Ramadan was 8.04 years compared with 8.07 years in non-Ramadan months (P = 0.037). Blunt trauma was the most common type in both groups. The median of the Injury Severity Score was the same and equal to 4. In both groups, neurological and vascular injuries were more common in Ramadan: P = 0.02 and P = 0.03 respectively.Conclusion There were no significant differences between trauma in Ramadan and non-Ramadan months, except for the higher percentage of vascular and neurological injuries in Ramadan.Key words: children, head injury, motor vehicle accidents, Ramadan, Saudi, trauma, vascular injur
Unusual Presentation of Crohnâs Disease: Distal transverse colon mass
Crohnâs disease is an inflammatory chronic disease affecting the gastrointestinal tract, mostly the colon and terminal ileum. The most frequent presentation is a young patient presented to a tertiary care center in Riyadh, Saudi Arabia in 2021 with chronic diarrhea, rectal bleeding, and abdominal pain. It is unusual for patients with Crohnâs disease to develop a benign large colon mass. In this case report, a female patient presented with chronic abdominal pain. The computed tomography findings showed a transverse colon mass invading the stomach. The biopsy report indicated reactive colonic mucosa with focal inflammatory exudate. She underwent a laparoscopic extended left hemicolectomy with en-bloc resection of the greater curvature of the stomach and primary anastomosis.
Keywords: IBD, Crohn's disease, colon mass, transverse colon, abdominal pain
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic
The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study
AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4âweeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4âweeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, PÂ =Â 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, Pâ<â0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, PÂ =Â 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, PÂ =Â 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease
The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study
Aim: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.
Methods: This was an international prospective cohort study of consecutive colorectalcancer patients with a decision for curative surgery (JanuaryâApril 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision,in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored theeffects of delay in elective patients only. The impact of longer delays was explored in asensitivity analysis. The primary outcome was complete resection, defined as curative
resection with an R0 margin.
Results: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operatedpatients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks.Delayed patients were more likely to be older, men, more comorbid, have higher bodymass index and have rectal cancer and early stage disease. Delayed patients had higherunadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates ofemergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90â1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69â1.27, P = 0.672). Longer delays were not associated with poorer outcomes.
Conclusion: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long- term survival attributable to delays is likely to be due to micro-metastatic disease
Timing of surgery following SARSâCoVâ2 infection: an international prospective cohort study
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4â1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0â2 weeks, 3â4 weeks and 5â6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3â4.8), 3.9% (2.6â5.1) and 3.6% (2.0â5.2), respectively). Surgery performed â„ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9â 2.1%)). After a â„ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2â8.7) vs. 2.4% (95%CI 1.4â3.4) vs. 1.3% (95%CI 0.6â2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms â„ 7 weeks from diagnosis may benefit from further delay
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous