bluuebunny/crossref_metadata_2025_split huggingface dataset:
664 The ICON Trauma Study: The Impact of the COVID-19 Lockdown on Major Trauma Workload in the UK
Authors: Adiamah A , Thompson A i , Lewis-Lloyd C , Dickson E , Blackburn L , Moody N , Gida S , La Valle A , Reilly J J , Saunders J , Brooks A ,   ICON Trauma Study Group
Published: May 2021

Abstract

Introduction
Anecdotal evidence suggest a direct impact of the SARS-COV-2-pandemic on presentation and severity of major trauma.

Method
This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/2019). Demographic differences, injury method and severity were compared using Fisher’s and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality.

Results
Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p &lt; 0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk of mortality in the 2020 cohort that in adjusted models, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increased mortality on multivariable analysis.

Conclusions
Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.
720 Outcomes of Conservative Management of Acute Appendicitis During The COVID-19 Pandemic
Authors: Oxenham M , Jull P , Karunaratne D , Laskar N , Harshen R 
Published: May 2021

Abstract

Introduction
During the SARS-CoV-2 (COVID-19) pandemic, appendicitis was managed conservatively to reduce peri-operative mortality; spread of infection; and hospital admissions. We describe the outcomes observed from conservative management during the pandemic.

Method
This prospective single centre study included all patients with clinically acute appendicitis between 31/3/2020 to 31/5/2020. Length of admission and 30-day complications were recorded. This was compared to retrospective data from 31/3/2019 to 31/4/2019.

Results
Of the 35 patients included between 31/3/2020 to 31/5/2020: 19 patients were managed conservatively with antibiotics; 8 required operative management after trial of antibiotics; and 8 required surgery on admission. Of the initially conservatively managed patients, three suffered complications (Clavien Dindo &gt;1). Length of admission in conservative patients averaged 1.3 days (0-5 day range).
In May 2019, 30 patients admitted with clinical appendicitis were all managed with appendicectomy. The average admission was 2.93 days (1-50 day range) with 4 patient complications. There was no difference (P = 0.22) when comparing the length of admissions within the pandemic and non-pandemic cohorts.

Conclusions
Our study demonstrates no increase in complications or length of admission during the pandemic. We support the recommendation that conservative management of uncomplicated appendicitis is continued during the COVID-19 pandemic.
729 Effect Of COVID-19 On Orthopaedic Trauma Admissions in A London District General Hospital
Authors: Zahoor U , Malik C , Raja H , Ramaraju S , Sri-Ram K 
Published: May 2021

Abstract

Introduction
The coronavirus pandemic (COVID-19) has presented orthopaedic services with new challenges across all aspects of healthcare delivery. This study explores the effect of the COVID-19 lockdown on trauma admissions at a London District General Hospital.

Method
Data was collected retrospectively from electronic patient records during the lockdown period (16th March -30thApril 2020) and compared to the same dates in 2019. Patient age, date and time of admission, operation and anaesthesia timings and length of stay (LOS) were analysed.

Results
Fewer trauma patients were admitted in 2020 (108 vs. 65). Additionally, there was a patient demographics shift, with mean age increasing from 55.6 years to 64.1 years (p = 0.038). Falls remained the leading cause of injury, although the proportion dropped from 75% to 62%. Anaesthesia duration was longer in 2020 (136 vs 83 minutes, p &lt; 0.00001). Similarly, there was a 13.6% increase in median operation length. Finally, although LOS was similar, admission-operation was greatly reduced in 2020 (1.22 days vs 4.74, p &lt; 0.0000001).

Conclusions
Orthopaedic trauma care remains a vital service, particularly in high-volume hospitals. By understanding the effects of the lockdown on trauma admissions, healthcare managers can more effectively plan for future changes in non-emergent trauma service delivery as we move towards easing lockdown restrictions.
739 The Management and Outcomes of Patients with Fractured Neck of Femur During The COVID-19 Pandemic; A District General Hospital Experience
Authors: Lancaster P , Selvarajan S , Dasari K 
Published: May 2021

Abstract

Background
The UK announced a “lockdown” in response to COVID-19 on 23/03/2020, despite this NHS England did not anticipate a significant decrease in hip fracture cases. Early data from Europe had shown mortality rates of up to 30.4% in patients who develop COVID-19 and a hip fracture.

Method
Prospective study of patients presenting with a hip fracture between 23/03/2020 and 18/05/2020. Primary outcomes were 30-day mortality and COVID-19 status. Secondary outcomes were length of stay, discharge destination and readmission.

Results
50 patients identified, mean age 82. 49 patients underwent operation, 34 (69.4%) within 48 hours of admission. 14 Patients (28%) tested positive for COVID-19 within 30 days. 30-day mortality was 10% (n = 5). 2 patients who died were COVID-19 positive. Mean length of stay was 12.3 days. 7 patients (14%) re-admitted within 30 days, 4 with COVID-19.

Conclusions
Despite extra strain on the hospital, we believe we achieved good outcomes for this cohort. Compared to previous NHFD data we decreased our length of stay and time to operation. 30-day mortality increased (8.4% in 2018) but we believe this to be expected in vulnerable patients during a pandemic. We hope to take lessons we have learnt during the pandemic into the post-pandemic era.
786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic
Authors: Huang J , Bhargava E , Walsh M , Pennell D , Attya H , Jablenska L , Ferguson L , Lilly I , Pepper C , Tweedie D , Possamai V 
Published: May 2021

Abstract

Introduction
Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A &lt; 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population.

Method
Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020.

Results
61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID.

Conclusions
Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.
815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown
Authors: Nicholls J , Stewart C , Coulston J 
Published: May 2021

Abstract

Introduction
The emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit.

Method
Data on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database.

Results
92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%).
There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10).

Conclusions
The lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.
816 The Effect Of COVID-19 And Service Delivery Changes On 30-Day Mortality in Fractured Neck of Femur Patients: A Case-Control Study
Authors: Winarski A , Williams L , Ingoe H 
Published: May 2021

Abstract

Introduction
The majority of neck of femur (NOF) fractures occur within the home, therefore admissions were not expected to change during the COVID-19 pandemic(1) . This study investigates the effect of coronavirus and our department’s response on 30-day mortality for patients admitted with NOF fractures.

Method
Data from 65 fractured NOF admissions (22nd March - 24th May 2020) was compared with 62 patients from the same period in 2019. Binary logistic regression was used to explore 30-day mortality; accounting for differences in ASA, anaesthetic type, anticoagulation status, surgery type, age, time to surgery and year of admission.

Results
The odds of 30-day mortality was statistically significantly higher in patients who were suspected/confirmed COVID-19 positive (n = 10),(OR 2.39, 95%CI (1.60-74.13)). In COVID-19 negative patients (n = 55), the odds of 30-day mortality was lower in 2020, and approached statistical significance (0.232, 95%CI (0.053-1.02)), compared to the same period in 2019. Median length of stay (LOS) in patients who survived was 11 days in 2020 and 15.5 days in 2019 (p = 0.003).

Conclusions
The results suggest that a COVID-19 diagnosis significantly increases the 30-day mortality in patients with a fractured NOF. The changes implemented in service delivery have shortened LOS and appeared to improve 30-day mortality for those without COVID-19.
890 Predictive Factors for Mortality Following Trauma & Orthopaedic Surgery in The Covid-19 Pandemic. The Manchester Equation
Authors: Waugh C , Jain N , Bhutta A , Havenhand T , Qureshi M , Stansfield J , Lokanathan S 
Published: May 2021

Abstract

Introduction
Covid-19 caused many service changes including limitations on operations due to potential increased mortality risk to patients. We report our findings from Trauma & Orthopaedic (T&O) surgical mortality through this period and the effectiveness of using a scoring system (The Manchester Equation) to predict likelihood of mortality.

Method
We reviewed all T&O admissions that underwent surgical intervention during the height of the pandemic. We recorded numerous factors for each patient including mortality and Covid status. From this we created a scoring system which is the product of Covid status, Anaesthetic type, Medical co-morbidities and other medical factors and ASA Score. We then analysed the findings to determine whether the score could be predictive of mortality rate.

Results
Of 123 patients undergoing surgery 6 deaths were observed (mean score of 51.3) compared to 117 patients surviving (mean score 31.9), p = 0.001. A score of less than 32 carried a 0% chance of death whereas a score of 32 or more resulted in a 14.6% mortality rate (p = 0.01).

Conclusion
The Manchester Equation can be used to help predict the mortality rate of T&O surgery in the presence of Covid-19 and may be useful for clinical decision making and consent purposes.
905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic
Authors: Subbiah Ponniah H , Ahmed M , Edwards T , Cobb J , Dean E , Clark C , Logishetty K 
Published: May 2021

Abstract

Introduction
There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites.

Method
An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit).

Results
21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p &lt; 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery.

Conclusions
We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.
907 Reduction of Nasal Fractures During COVID-19: A Single-Centre Experience
Authors: Crotty T , Corbett M , Hussain T , Diaconescu A , Patil N 
Published: May 2021

Abstract

Introduction
The utilization of local or regional anaesthesia for manipulation of nasal fractures (MNF) avoids the need for general anaesthetic (GA), and the risk associated with instrumentation of the airway during the COVID-19 pandemic. Furthermore, MNF under local anaesthetic (LA) provides similar results with regards to cosmesis and patient satisfaction. We present our experience of performing MNF under LA during the COVID-19 pandemic.

Method
A single-centre, prospective study of all patients undergoing MNF under LA was conducted (13th July/20–11thSeptember/20). Following reduction, pain scores and patient satisfaction surveys were administered.

Results
A total of 25 patients (M/F:16/9, median age, 25.6yr (14-52yr)) were enrolled. The majority of patients received either one or two instillations of LA (n = 19, 76%). Pain reported during the MNF procedure was 4.4/10, whilst pain during LA administration was reported as 3.2/10. 80% of patients felt instillation of LA was less painful than expected. 88% of respondents tolerated the LA well, and only 8% would have opted for general anaesthetic. 24 (96%) participants were happy with the cosmetic result.

Discussion
MNF under LA is a safe and effective alternative to MNF under GA. More literature is needed to define the best method of administering LA prior to performing MNF.
936 Outcomes of A Single Site Receiving Model for General Surgery During the COVID-19 Pandemic in A Scottish NHS Board
Authors: Kilpatrick R , MacDonald A 
Published: May 2021

Abstract

Aim:
To assess overall patient outcomes of converting to a single-site receiving unit for general surgery during the height of the covid-19 pandemic.

Method
Prospective study of all general surgery inpatients, who would normally be looked after at University Hospital Monklands, between 17/04/20-06/06/20, the beginning and end of a single-site receiving model within NHS Lanarkshire.

Results
There was a 32% reduction in admissions from 278 to 188, from the same time period in 2019. The 30-day mortality rate was 3.2% in comparison to 2.8% in 2019.
Of 59 patients (31.4%) who had surgery, 13.5% had a complication of varying degree. The post-operative 30-day mortality rate was 0%. Only 4 patients (2%) were diagnosed with covid-19, none of which died.
Laparoscopic appendicectomy was favoured over conservative management, with average length of stay (LoS) being 3.2 days and 5 days respectively. Acute cholecystitis was overall managed conservatively with average LoS being 8.8 days for operative management, compared to 4.1 days for conservative management.

Conclusions
Overall outcomes during this time were not found to be significantly worse when compared to the previous year. The rate of contracting covid-19 in the unit was low. Laparoscopic surgery can still be carried out safely for selected acute surgical conditions.
954 A Framework Recommendation for Surgeons Legal Liabilities During an Acute Health Crisis
Authors: Schaffer S , O’Neill P , Thomas M C 
Published: May 2021

Abstract

Introduction
Ethical and professional duties compelled surgeons to act outside their specialties during the SARS-CoV-2 pandemic. Our work explored the legal liabilities that have arisen for surgeons during this period.

Method
A literature review was conducted of medical and legal databases; PubMed, MedlineOvid, WestLaw, and LexisNexis. Statues and case law across three jurisdictions; Canada, the United Kingdom, and the Republic of Singapore were retrieved and analyzed.

Results
Professional regulatory bodies impose a duty to act in healthcare emergencies. Yet, formal legal protection has not been codified by either professional regulatory bodies or governments. These discrepancies between legal and professional standards leave surgeons vulnerable to litigation.

Conclusions
Following our analysis of cases and outcomes within these jurisdictions we propose a framework that provides basic protection to surgeons acting outside their surgical specialty, but within a general medical capacity, whilst providing care during acute health crises.
971 Impact Of COVID-19 Surgical Guidelines on Sternal Wound Infections During The COVID-19 Pandemic in A Large London Hospital: An Unexpected Benefit
Authors: Ike I D , Durand-Hill M , Hussain A 
Published: May 2021

Abstract

Introduction
Sternal wound infections (SWI) are typically associated with a high morbidity and mortality. Rigorous peri-operative guidelines were instituted during the pandemic. The impact of these measures on SWI was investigated.

Method
We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since March 2020 post intervention (new COVID-19 peri-operative guidelines). A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the lockdown was also performed as a baseline cohort group.

Results
A total of 2,600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. 67 (2.6%) surgical wound infections occurred in the study population. During the COVID pandemic, there were 4 SWIs with an overall incidence rate of 0.8%. Patients who underwent cardiac surgery during the COVID pandemic had a lower than expected rate of surgical wound infections (P = 0.006). Other significant predictors of surgical wound infections included a diagnosis of diabetes and being a smoker.

Conclusions
This report suggests that a significant proportion of SWI’s are iatrogenic related and can be avoided through a rigorous attention to detail in the peri-operative setting.
998 Utilisation of A “COVID-Free” Hospital in The Independent Sector - Endourology Service Provision and Outcomes During The COVID-19 Pandemic
Authors: Bratt D , Satherley H , Konstantinidi K , Ratan H , Bodiwala D 
Published: May 2021

Abstract

Introduction
COVID-19 may negatively affect peri-operative outcomes, requiring strategies to allow operating whilst minimising risk. We present our endourology service provision throughout the “lockdown” period.

Method
Endourological operations 23rd March to 11th May 2020 were designated to the base hospital or independent “green” site by urgency and comorbidity status. Base hospital emergencies underwent surgery in main theatres, whilst elective patients had dedicated “COVID-free” theatres and wards.
A portable Holmium laser enabled lasertripsy at the independent site.
After 27th April, elective cases required a negative swab and 2-week self-isolation pre-operatively.

Results
70 operations were performed: 42 ureteroscopies, 20 stent procedures, 8 PCNLs. Mean age was 57 and 58 at base and independent sites respectively, mean ASA 2.1 and 1.9.
37 operations (53%) occurred at the base hospital, including 14 emergencies (38%). 19 patients received post-operative COVID-19 swabs: 3 positives (8%), all emergencies. 2 patients (5%) died of COVID-19 pneumonia within 35 days; both had negative pre-operative swabs.
Of 33 patients at the independent site, 3 (9%) received post-operative swabs, all negative. None had COVID-19 symptoms post-operatively.

Conclusions
“COVID-free” hospitals, wards and theatres enable elective operating whilst minimising peri-operative virus risk. Further utilisation of independent hospitals would more safely allow operating throughout the pandemic.
1017 Audit of Sore Throat Management During the COVID-19 Pandemic
Authors: Eastwood M , Lovett A , Metcalfe C , Bhimrao S 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has meant otolaryngologists have faced significant uncertainty and has them to change their clinical practice. ENT UK published guidance on the management of common emergencies encountered aimed to optimise safety for patient and clinician alongside reducing admission rate. We present an audit of our management of patients presenting with sore throat during the COVID-19 pandemic.

Method
Prospective data collection was undertaken between 1st April 2020 and 1st July 2020, inclusive. All patients presenting acutely to ENT services with sore throat were reviewed. Local practice was compared to the ENT UK COVID-19 adult tonsillitis and quinsy management guidelines published on 6th April 2020.

Results
A total of 19 patients presented to the ENT department with an acute sore throat during the audit period. Twelve patients were tested for SARS-CoV-2, with all results being negative. All patients underwent an oral examination on review. Seventy-nine percent were discharged within 24 hours of admission. One patient required readmission within 30-days.

Conclusions
With reduction in admissions, these results provide otolaryngologists with the reassurance for change of clinical practice. We recommend that for future practice to be safe for both patient and practitioner, the ENT UK guidelines are used to aid clinical decision-making especially during the COVID-19.