Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board

Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P  70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high

Clinical and microbiological investigation into mixed growth urine cultures

Introduction. Urine samples submitted for investigation of urinary tract infection (UTI) may identify more than one bacterial isolate. These samples may be reported as ‘mixed growth urine culture’ (MGUC). The clinical significance of MGUC remains controversial. Hypothesis/Gap Statement. The impact of MGUC on patient management is not known and should be assessed. To describe MGUC and assess its impact on patient management. Methodology. Microbiology laboratory reports (Leeds, UK) were retrospectively analysed and urine cultures reported as MGUC from a 1 week period underwent detailed laboratory analysis. Semi-structured interviews of NHS clinicians’ response to MGUC reports were explored for emergent themes. Results. In 2018, 12.4 % (14,323/115,664) of urine specimens processed to detect bacterial pathogens were reported as MGUC. Among a total of 200 MGUC samples identified within 1 week in 2019, detailed laboratory analysis identified 459 bacterial isolates. Enterococcus species (30.1 %) and Escherichia coli (27.5 %) were the most frequently isolated and the most frequent organism combination (24 %). In total, 65.5 % cultures contained two organisms and 82.5 % of all MGUC contained at least one Enterobacterales. Interviews found clinicians believed MGUC reports represented detection of many commensal bacteria. Clinicians indicated they were more likely to diagnose and treat a UTI when provided with urine culture reports derived from detailed microbial analysis of MGUC, including identity and antibiotic sensitivity of organisms. Conclusions. This study highlights the potential underuse of information derived from microbiological analysis of urine samples. Interpretive commentary on reports together with education for interpretation of enhanced reports should be explored further to improve outcomes in patients with UTI

Orthogonal-Based Second Order Hybrid Initial Value Problem Solver

This work focuses on development of an initial value problem solver by employing a new class of orthogonal polynomial, the basis function. We present the recursive formula of the class of polynomials constructed and adopt collocation technique to develop the method. The method was analyzed for its basic properties and findings show that the method is accurate and convergent.AMS Subject Classification: 65L05, 65L06 Keywords: Orthogonal polynomials, Algorithm, Block method, Collocation, Interpolation, Zero-Stable