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Challenges of General Surgery during the COVID-19 Pandemic

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Dr. Vittorio Bresadola

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General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, 33100 Udine, Italy
Interests: general surgery; colorectal surgery; transplantation

Special Issue Information

Dear Colleagues,

On March 11th, 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic, with most of the highly revered national healthcare systems being caught underprepared. Major factors were the low beds- and doctors-per-population ratios, combined with the general lack of experience with recent epidemics. The risk of infection to the surgical workforce through direct contact with infected vectors has led to changes in surgical practice. This has led to an increased risk profile of surgery for both patients and operative teams. Routine procedures such as open suctioning, smoke generation and the opening of pressurized spaces have been considered high-risk. To mitigate these risks, surgical services have made changes to their practice. The challenges mainly involve two fields: surgical patients and surgical procedures. This special issue aims to provide a comprehensive review of these challenges by collecting papers from an expert panel of authors.

Dr. Vittorio Bresadola
Guest Editor

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20 pages, 592 KiB

Open AccessArticle

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients

by Yasin Dalda, Sami Akbulut, Zeynep Kucukakcali, Zeki Ogut, Ozlem Dalda, Saadet Alan and Burak Isik

J. Clin. Med. 2024, 13(24), 7673; https://doi.org/10.3390/jcm13247673 - 16 Dec 2024

Viewed by 582

Abstract

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom–Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients. Full article

(This article belongs to the Special Issue Challenges of General Surgery during the COVID-19 Pandemic)

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13 pages, 1021 KiB

Open AccessArticle

Dynamic Trends in Surgical Oromaxillofacial Trauma Epidemiology: A Comparative Study of Pre-COVID-19 and COVID-19 Periods in Tertiary Referral Hospitals in Madrid

by Angela Sada-Urmeneta, Manuel Tousidonis, Carlos Navarro-Cuellar, Santiago Ochandiano, Ignacio Navarro-Cuellar, Saad Khayat, Gonzalo Ruiz-de-León, Marta Benito-Anguita, Sara Alvarez-Mokthari, Eduardo Olavarria, Gregorio Sanchez-Aniceto, Sonia Herrero-Alvarez, Oscar de la Sen-Corcuera, Anna-Maria Simon-Flores, Fernando Almeida-Parra, Iñigo Aragon-Niño, Jose-Luis del-Castillo and Jose-Ignacio Salmeron

J. Clin. Med. 2024, 13(7), 1947; https://doi.org/10.3390/jcm13071947 - 27 Mar 2024

Viewed by 1112

Abstract

Introduction: The COVID-19 pandemic has induced profound societal and healthcare transformations globally. Material and methods: This multicenter retrospective study aimed to assess potential shifts in the epidemiology and management of oromaxillofacial trauma requiring surgical intervention over a 1-year period encompassing the onset of the COVID-19 pandemic, in comparison to the preceding year. The parameters investigated included age, sex, injury mechanisms, fractured bones, and treatment modalities. The statistical significance was set at p < 0.05. Results: A notable 39.36% reduction in oromaxillofacial fractures was identified (p < 0.001), with no significant alterations in sex distribution, types of fractured bones, or treatment modalities. An appreciable increase in mean age was observed (35.92 vs. 40.26) (p = 0.006). Analysis of the causes of oromaxillofacial trauma revealed diminished incidents of interpersonal violence (41% vs. 35%) and sports-related injuries (14% vs. 8%), alongside an escalation in cases attributed to falls (27% vs. 35%), precipitation events (2% vs. 5%), and traffic accidents (12% vs. 13%). The mandible emerged as the most frequently fractured bone. Conclusion: In conclusion, the COVID-19 pandemic has decreased the number of maxillofacial fractures treated surgically and has changed the epidemiology and the etiology of facial traumas. Full article

(This article belongs to the Special Issue Challenges of General Surgery during the COVID-19 Pandemic)

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