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

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.

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

More extensile osteotomy in the treatment of posterior calcaneal osteophyte (Haglunds disease)

The aim of this study is to present a more extensile osteotomy performed for the treatment of Haglunds disease and the results of 2-year follow-up of these patients.Fifteen feet of 15 patients who underwent open surgery by the same surgeon between 2011 and 2015 were included in the study. In this technique, the Achilles tendon is split into two in the middle and tenotomized at its insertion. Retrocalcaneal bursa and exocytosis is completely excised and tenodesis of the Achilles tendon to its old insertion is performed with the help of two 5 mm suture anchors. All patients were discharged on the postoperative first day. Postoperatively, a short leg plaster cast was applied for six weeks with the ankle in slightly plantar flexed position. For the next six weeks, patients were followed up with an ankle foot orthosis with the ankle in neutral position. At the end of the third month, orthosis treatment was discontinued in all patients. The patients were evaluated with the visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores (FAOS) preoperatively and at 3 months postoperatively. The mean follow-up period was 27.4 months. A statistically significant difference was found between preoperative and postoperative for both VAS and FAOS scores (p [Med-Science 2019; 8(4.000): 923-6

A successfully treated case of necrotizing fasciitis with complicated sepsis due to intramuscular steroid injection

Necrotising fasciitis is a devastating soft tissue infection which characterised by rapidly progressing necrosis involving mainly fascia and subcutaneous tissues. A 66-year old male patient with chronic obstructive pulmonary disease admitted to our hospital with fever, pain and swelling in the right thigh and right leg, difficulty in walking, dry mouth and weakness. There was a single dose intramuscular steroid injection story in his anamnesis. Physical examination revealed swelling, hyperemia and pain in the right gluteal region spreading through the right femur and popliteal fossa. He was diagnosed necrotizing fasciitis complicated with sepsis. We administered the supportive therapy and broad-spectrum antibiotic therapy in addition to the surgical debridement, vacuum assisted closure and hyperbaric oxygen therapy. The patient was discharged after six months of the follow-up period in hospital. In conclusion, Health-care personnel should be careful when the intramuscular injections planned for patients at the risk of development of necrotizing fasciitis reason of their chronic illnesses or immunosuppressive conditions. In patients who developed necrotizing fasciitis despite everything, we want to strongly emphasise the advantageous hyperbaric oxygen therapy as an additional therapy to the broad spectrum antibiotherapy and surgical debridement [Cukurova Med J 2016; 41(4.000): 787-791

Pedobarographic measurements after repair of Achilles tendon by minimal invasive surgery

Objective:The aim of the study was to assess the changes of plantar foot pressures with pedobarography in patients with Achilles tendon repair by minimally invasive surgical technique.Materials and Methods:This retrospective study consisted of 15 consecutive patients who were operated between 2010 and 2012.The mean age was 28.7 years (24-42) and the mean follow-up time was 2.3 years (1.5-3).All patients had sports related Achilles' tendon rupture and all had undergone surgery in 24-48 hours.Peak and mean heel and forefoot pressures in injured extremity were measured by pedobarograph and compared with noninvolved foot.Results:There wasn’t any complication associated with surgery such as wound problems, rerupture or neurologic injury.Only three patients had some numbness at the incision site.When we compare the mean foot pressures between the operated foot and the normal foot, there was no statistical difference about peak and mean heel and forefoot plantar pressure between involved site and non involved site.Conclusions:As a result, Achilles tendon repair with minimal invasive technique and early rehabilitation may prevent changes of plantar foot pressure distribution

A seven-toed central polydactyl in an adult: A neglected, unclassifiable case

The aim of this study was to present a neglected, unclassifiable case that involved a central type polydactyl adult with 7 toes and metatarsals, 4 cuneiforms and 1 cuboid. A 22 year-old male soldier with a right polydactyl was referred to our hospital. He suffered from the need of excessively wide-shoes and occasional shoe irritation. He was evaluated with plain radiography and 3D tomography. The patient had central-type polydactyl with 7 toes and metatarsals, and 4 cuneiforms and 1 cuboid. Ankles and hind feet were completely normal. All toes were capable of tendon flexion and extension. His medical and family history was unremarkable. We planned to excise the excessive toes and metatarsals, but the patient denied the surgery. We present a very rare case with a central polydactyl having 7 toes and metatarsals, 4 cuneiforms and 1 cuboid. The striking point in our case was that he was a neglected, unclassifiable case. [Arch Clin Exp Surg 2017; 6(1.000): 45-48