Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Gastrointestinal Surgery, Nord University Hospital, Marseille, France.
Department of General Surgery, Sainte-Anne Military Teaching Hospital, Toulon, France.
Ir J Med Sci. 2021 Nov;190(4):1309-1315. doi: 10.1007/s11845-020-02465-3. Epub 2021 Jan 15.
The brutal COVID-19 pandemic has majorly impacted populations and health systems, and surgeons have observed dramatic changes in their daily clinical activities. A survey of French digestive surgeons was conducted to assess these changes.
An electronic survey was sent to French digestive and general surgeons in the Societe Francaise de Chirurgie Digestive (SFCD) to assess the surgeons' daily activity during the pandemic and investigate changes in patients' management. The care deviations were classified as delay of management, modification of strategy, or modification of organization, and the impact of these changes on patients was evaluated by the surgeon's estimation of loss of chance.
A major reduction in surgical elective activity was observed in 50 (75%) of the 67 hospitals that responded. Of these, 48 hospitals (71.6%) reported receiving SARS-CoV-2 patients. A deviation from usual care was observed in 10% of patients admitted for emergency general surgery. Among 140 patients presenting a deviation from usual care, 74 (52.9%) had delayed management, 53 (37.9%) had a modification of strategy, and 64 (45.7%) had a modification of organization. Medical treatment instead of surgical treatment was decided for 37 (26.4%) patients, resulting in a high loss of chance for 6 patients. Delays (p < 0.001) and a switch from surgical to medical treatment (p = 0.002) were independently correlated with overall loss of chance based on multivariate analysis.
This study highlighted the deviations in general emergency surgery patients and provided implications for the solutions that should be implemented during a new health crisis.
残酷的 COVID-19 大流行对人口和卫生系统造成了重大影响，外科医生观察到他们日常临床活动发生了巨大变化。对法国消化外科医生进行了调查，以评估这些变化。
向法国消化和普通外科医生协会 (SFCD) 的法国消化外科医生发送了电子调查，以评估外科医生在大流行期间的日常活动，并调查患者管理的变化。护理偏差分为管理延迟、策略修改或组织修改，并由外科医生对机会丧失的估计来评估这些变化对患者的影响。
在做出回应的 67 家医院中有 50 家（75%）观察到手术择期活动大幅减少。其中，48 家医院（71.6%）报告接收了 SARS-CoV-2 患者。在因紧急普通外科手术入院的患者中观察到常规护理的偏差。在 140 名出现常规护理偏差的患者中，74 名（52.9%）的管理延迟，53 名（37.9%）的策略修改，64 名（45.7%）的组织修改。37 名（26.4%）患者决定进行药物治疗而非手术治疗，导致 6 名患者机会丧失很大。延迟（p<0.001）和从手术治疗转为药物治疗（p=0.002）在多变量分析中与总体机会丧失独立相关。
本研究强调了普通急诊手术患者的偏差，并为新的卫生危机期间应实施的解决方案提供了启示。
