Letter to the Editor: Assessing the Long-Term Potential of Relaxing Regulations: Should We Go Back to Business as Usual?

The response to the COVID-19 pandemic resulted in reallocation of health care resources and removal of barriers to deliver expedited care to those in need. This might be a unique moment in history to reconsider the regulations within our health care system that significantly increase its cost. Keywords: COVID-19; health care cost; regulations

Perioperative Considerations During Emergency General Surgery in the Era of COVID-19: A U.S. Experience

The novel coronavirus SARS-CoV-2 (COVID-19) strain has caused a pandemic that affects everyday clinical practice. Care of patients with acute surgical problems is adjusted to minimize exposing health care providers to this highly contagious virus. Our goal is to describe a specific and reproducible perioperative protocol aiming to keep health care providers safe and, simultaneously, not compromise standard of care for surgical patients

Long term results on the severity of acute appendicitis during COVID-19 pandemic

Background: Acute appendicitis cases increased in severity following COVID-19 related restrictions in March, 2020 [1,2]. We investigated if similar changes occurred during Wave 2. Methods: Acute appendicitis patients during Wave 1 were grouped 8 weeks before (Group A) and after (Group B) stay-at-home restrictions were initiated on March 15, 2020. Cases in Wave 2 were grouped 8 weeks before (Group C) and after (Group D) November 6, 2020. Groups were compared to equivalent time frames in 2018/2019. Results: Group A vs B revealed 42.6% decrease (CI: - 59.4, - 25.7) in uncomplicated appendicitis, and 21.1% increase (CI: 4.8, 37.3) in perforated appendicitis. Similar patterns were noted comparing Group C vs D without statistical significance. The changes seen in Wave 1 were significantly different than in 2018/2019. This trend continued in Wave 2. Conclusions: Similar to Wave 1, acute appendicitis cases increased in severity during wave 2 of COVID-19, but with less prominence. Keywords: Appendicitis; COVID-19; Incidence; Pandemic; Severity

Increasing incidence of complicated appendicitis during COVID-19 pandemic

Background: The novel coronavirus (COVID-19) strain has resulted in restrictions potentially impacting patients presenting with acute appendicitis and their disease burden. Methods: All acute appendicitis admissions (281 patients) between 1/1/2018-4/30/2020 were reviewed. Two groups were created: 6 weeks before (Group A) and 6 weeks after (Group B) the date elective surgeries were postponed in Massachusetts for COVID-19. Acute appendicitis incidence and disease characteristics were compared between the groups. Similar time periods from 2018 to 2019 were also compared. Results: Fifty-four appendicitis patients were categorized in Group A and thirty-seven in Group B. Those who underwent surgery were compared and revealed a 45.5% decrease (CI: 64.2,-26.7) in uncomplicated appendicitis, a 21.1% increase (CI:3.9,38.3) in perforated appendicitis and a 29% increase (CI:11.5,46.5) in gangrenous appendicitis. Significant differences in the incidence of uncomplicated and complicated appendicitis were also noted when comparing 2020 to previous years. Conclusions: The significant increase in complicated appendicitis and simultaneous significant decrease in uncomplicated appendicitis during the COVID-19 pandemic indicate that patients are not seeking appropriate, timely surgical care. Keywords: Acute appendicitis; COVID-19; Complicated appendicitis

Feasibility and Acceptance of a Tele-Trauma Surgery Consult Service to Rural and Community Hospitals: A Pilot Study

Background: Many trauma patients currently transferred from rural and community hospitals (RCH) to Level 1 trauma centers (L1TC) for trauma surgery evaluation may instead be appropriate for immediate discharge or admission to the local facility following evaluation by a Trauma and Acute Care Surgery (TACS) surgeon. Unnecessary utilization of resources occurs with current practice. We aimed to demonstrate the feasibility and acceptance of a Tele-Trauma Surgery Consultation (TTSC) service between L1TC and RCH. Study design: L1TC TACS surgeons provided telehealth consults on trauma patients from 3 local RCHs. After consultation, appropriate patients were transferred to L1TC; selected patients remained at or were discharged from RCH. Participating TACS surgeons and RCH physicians were surveyed. Results: 28 patients met inclusion criteria during the 5-month pilot phase, 7 excluded due to workflow issues. Mean (±sd) age 63 (±17) years. Seven of 21 patients had intracranial hemorrhage; 12 had rib fractures. Mean (±sd) injury severity score (ISS) was 8.1(± 4.0). Six patients discharged from RCH, four admitted to RCH hospitalist service, two transferred to a L1TC ER, and nine transferred to L1TC as direct admission. There was one 30-day readmission and no missed injuries or complications, or deaths. RCH providers were highly satisfied with the TTSC service, TACS surgeons, and equipment used. Mental demand and effort of consulting TACS surgeon decreased significantly as consult number increased. Conclusion: TTSC involving three RCH within our system is feasible and acceptable. Ten transfers and 19 ED visits were avoided. There was favorable acceptance by RCHs providers and TACS surgeons