53 research outputs found

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

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    Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

    Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

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    Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

    Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

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    : The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

    Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

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    We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Competitive Structure Of Turkish Basketball Leagues And Relationship With Sport Industry

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    Bu çalışmada, Türkiye Basketbol liglerinde faaliyet gösteren kulüplerin 2014-2017 sezonları için rekabet düzeyleri araştırılmıştır. Basketbol Süper Liginin yanı sıra iki alt lig olan Türkiye Basketbol 1. Ligi ve Türkiye Basketbol 2. Ligi (iki grup) incelemeye dahil edilmiştir. Alt ve üst liglerde rekabet düzeyleri hesaplanarak alt liglerden üst liglere çıkıldıkça rekabet düzeyinin değişip değişmediği (bozulup/bozulmadığı) yıllar itibariyle kıyaslanmıştır. Basketbol liglerinin piyasa yapısı ve rakebet düzeyleri yoğunlaşma endeksleri metedolojisinden hareketle belirlenmiştir. Literatürde en sık kullanılan "n" firmalı yoğunlaşma endeksi CR-4 ve Herfindahl Hirschman Endeksi (HHI) hesaplama yöntemleri kullanılmıştır. Analiz sonuçlarına göre, Süper Lig takımları arasında CR-4 yoğunlaşma endeksi skorları 2014, 2015, 2016 ve 2017 sezonları için sırasıyla 0.29, 0.27, 0.29 ve 0,30 olarak hesaplanmıştır. HHI sonuçlarına göre ise ilgili yıllarda sırasıyla 221, 193, 212 ve 229 olarak hesaplanmıştır. Yoğunlaşma endeksleri sonuçları bir bütün olarak değerlendirildiğinde Basketbol Ligleri tüm katagorilerde zayıf oligopolcü bir piyasa yapısına sahiptir. Türkiye Basketbol 2. Liginden Türkiye Basketbol 1. Ligine geçildikçe rekabet kısmen artmakta ise de en üst lig olan Türkiye Basketbol Süper liginde yeniden rekabet düzeyi (endeks skorları) bozulmaktadır. Genel olarak alt liglerde de üst liglerde de benzer bir rekabet düzeyi hakim olup bu rekabet düzeyi yıllar itibariyle değişmediği görülmektedirIn this study, the levels of competition for the 2014-2017 seasons of the clubs operating in Turkish Basketball leagues are investigated. In addition to the Basketball Super Lig, the Turkish Basketball 1st League and the Turkish Basketball 2nd League (two groups), which are two lower leagues, are included in the review. By computing competition levels in the upper and lower leagues, it is compared over the years whether the level of competition is changed (deteriorate / not deteriorate) as rising from the lower leagues to the upper leagues The market structure and competition levels of basketball leagues are determined by the methodology of concentration indices. The most commonly used in the literatür "n" firm concentration index CR4 and Herfindahl Hirschman Index (HHI) calculation methods are used. According to the analysis results, among the Super League teams the CR-4 concentration index scores are calculated as 0.29, 0.27, 0.29 and 0.30 for the 2014, 2015, 2016 and 2017 seasons respectively. According to HHI results, it is calculated as 221, 193, 212 and 229 respectively in the related years. When the results of the concentration indices are considered as a whole, the Basketball Leagues have a weak oligopolistic market structure in all the categories. As passing from Turkish Basketball 2nd League to Turkish Basketball 1st League competition partially increase, but the competition level (index scores) in the top league Turkish Basketball Super League deteriorate. In general, the lower leagues have a similar level of competition in the upper leagues and it is seen this level of competition does not change over the year

    Competitive Structure Of Turkish Basketball Leagues And Relationship With Sport Industry

    No full text
    Bu çalışmada, Türkiye Basketbol liglerinde faaliyet gösteren kulüplerin 2014-2017 sezonları için rekabet düzeyleri araştırılmıştır. Basketbol Süper Liginin yanı sıra iki alt lig olan Türkiye Basketbol 1. Ligi ve Türkiye Basketbol 2. Ligi (iki grup) incelemeye dahil edilmiştir. Alt ve üst liglerde rekabet düzeyleri hesaplanarak alt liglerden üst liglere çıkıldıkça rekabet düzeyinin değişip değişmediği (bozulup/bozulmadığı) yıllar itibariyle kıyaslanmıştır. Basketbol liglerinin piyasa yapısı ve rakebet düzeyleri yoğunlaşma endeksleri metedolojisinden hareketle belirlenmiştir. Literatürde en sık kullanılan "n" firmalı yoğunlaşma endeksi CR-4 ve Herfindahl Hirschman Endeksi (HHI) hesaplama yöntemleri kullanılmıştır. Analiz sonuçlarına göre, Süper Lig takımları arasında CR-4 yoğunlaşma endeksi skorları 2014, 2015, 2016 ve 2017 sezonları için sırasıyla 0.29, 0.27, 0.29 ve 0,30 olarak hesaplanmıştır. HHI sonuçlarına göre ise ilgili yıllarda sırasıyla 221, 193, 212 ve 229 olarak hesaplanmıştır. Yoğunlaşma endeksleri sonuçları bir bütün olarak değerlendirildiğinde Basketbol Ligleri tüm katagorilerde zayıf oligopolcü bir piyasa yapısına sahiptir. Türkiye Basketbol 2. Liginden Türkiye Basketbol 1. Ligine geçildikçe rekabet kısmen artmakta ise de en üst lig olan Türkiye Basketbol Süper liginde yeniden rekabet düzeyi (endeks skorları) bozulmaktadır. Genel olarak alt liglerde de üst liglerde de benzer bir rekabet düzeyi hakim olup bu rekabet düzeyi yıllar itibariyle değişmediği görülmektedirIn this study, the levels of competition for the 2014-2017 seasons of the clubs operating in Turkish Basketball leagues are investigated. In addition to the Basketball Super Lig, the Turkish Basketball 1st League and the Turkish Basketball 2nd League (two groups), which are two lower leagues, are included in the review. By computing competition levels in the upper and lower leagues, it is compared over the years whether the level of competition is changed (deteriorate / not deteriorate) as rising from the lower leagues to the upper leagues The market structure and competition levels of basketball leagues are determined by the methodology of concentration indices. The most commonly used in the literatür "n" firm concentration index CR4 and Herfindahl Hirschman Index (HHI) calculation methods are used. According to the analysis results, among the Super League teams the CR-4 concentration index scores are calculated as 0.29, 0.27, 0.29 and 0.30 for the 2014, 2015, 2016 and 2017 seasons respectively. According to HHI results, it is calculated as 221, 193, 212 and 229 respectively in the related years. When the results of the concentration indices are considered as a whole, the Basketball Leagues have a weak oligopolistic market structure in all the categories. As passing from Turkish Basketball 2nd League to Turkish Basketball 1st League competition partially increase, but the competition level (index scores) in the top league Turkish Basketball Super League deteriorate. In general, the lower leagues have a similar level of competition in the upper leagues and it is seen this level of competition does not change over the year
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