Exploitation and Joint Action

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30-Day Mortality and Cardiopulmonary Complication Rates in Patients Undergoing Emergency Surgery with Perioperative SARS-CoV-2 Infection

INTRODUCTION AND OBJECTIVE: Continued vigilance of operative outcomes in COVID-19 patients is important given the relative novelty of the SARS-CoV-2 infection. We sought to evaluate the 30-day mortality and cardiopulmonary complication rates in patients undergoing emergency surgery with perioperative COVID-19, in comparison to a control group of medically managed COVID-19 patients that did not require a surgical intervention. METHODS: A retrospective chart review at a single tertiary-care hospital in Michigan was undertaken. Patients who had tested positive for SARS-CoV-2 infection either 7 days before or within 30 days after surgery during March-May 2020 were included in the study (n=52). Propensity score matched (1:6) patients who had been positive for SARS CoV-2 infection during this time-period but did not undergo surgery served as controls (n=314). The primary endpoint was 30-day mortality. Secondary endpoints included cardiac and pulmonary complications. Multivariable logistic regression analyses were utilized to account for baseline differences. RESULTS: The 30-day mortality (17.3% vs 13.1%, p=0.408) and cardiac (28.9% vs 19.1%, p=0.107) and pulmonary complication (55.8% vs 49.4%, p=0.392) rates were similar in the surgical and the non-surgical groups. Multivariable analyses confirmed that emergency surgical intervention was not associated with increased odds for any of the studied adverse events (p\u3e0.10 for all 3 endpoints). CONCLUSIONS: Our analysis of 366 novel coronavirus patients demonstrates that patients undergoing emergency surgery with SARS-CoV-2 infection do not have an increased risk for 30-day mortality and cardiopulmonary complications compared to their counterparts that do not require surgery. The importance of this study is that an emergency intervention does not portend a poorer prognosis among patients with a confirmed SARS-CoV-2 Infection

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Patient Tolerability with Office Transperineal Biopsy Using a Reusable Needle Guide

INTRODUCTION: Transrectal ultrasound-guided (TRUS) prostate biopsy is associated with a 1-5% risk of severe sepsis, despite the use of prophylactic antibiotics. Recent studies have demonstrated the feasibility of transperineal (TP) prostate biopsy in the outpatient setting under local anesthetic (LA). We demonstrate the safety, efficacy, and tolerability of our technique for performing TP biopsy under LA in the clinic setting using a reusable needle guide. MATERIALS & METHODS: A biplanar ultrasound probe with an attached adjustable, reusable needle guide was evaluated for transperineal biopsy. A 17 gauge x 10 cm coaxial needle is attached to the needle guide. The skin is infiltrated, bilaterally, approximately 2 cm anterolateral to the anal verge with 1% lidocaine using a 25 gauge needle. A deeper prostatic block is then performed using a 20 gauge spinal needle. Administration of the anesthetic is delivered to the musculature of the pelvic floor, superficial-to-deep. Prostate samples are obtained using an 18 gauge x 25cm biopsy gun. All biopsies on a side can be obtained utilizing a single perineal skin puncture site. Patients who underwent office TP biopsy after May 2019 also completed a 10-item patient experience questionnaire regarding pain or discomfort experienced during the procedure. RESULTS: In 2019, a total of 74 patients underwent office TP prostate biopsy under local anesthesia using a reusable needle guide, while 564 underwent office TRUS biopsy. Prostate biopsy was positive for malignancy in 58.1% of TP patients vs 57.6% in TRUS patients (p=0.93). TP biopsy had a lower utilization of prophylactic antibiotics compared to TRUS biopsy: 33.8% vs 99.5% (p\u3c0.001), yet there were no admissions, UTI, or sepsis for TP patients, compared to 6 admissions (1.1%) for TRUS biopsy (p=0.01)). The mean VAS score ± SD for pain or discomfort caused by the overall office TP biopsy was 3.68 ± 1.96. CONCLUSION: We demonstrate that office TP biopsy under LA with a reusable needle guide can be safely introduced with equivalent cancer detection rates whilst nearly eliminating the risk of urinary sepsis. This was achieved while also significantly reducing the use of prophylactic antibiotics. The procedure was well tolerated, with the most common complaint being local infiltration of anesthetic. We believe that office TP biopsy under LA can be performed with good patient tolerability, as almost 94% of patients were willing to undergo the procedure again. There is also the potential for reduction in overall cost with the use of a reusable needle guide