Department of General Surgery, Nuvance Health, Danbury Hospital, Danbury, CT.
Department of Surgery, Waterbury Hospital, Waterbury, CT.
JSLS. 2021 Apr-Jun;25(2). doi: 10.4293/JSLS.2021.00006.
Operating-room procedures canceled due to the COVID-19 pandemic depleted hospital revenue and potentially worsened patient outcomes through disease progression. Despite safeguards to resume elective procedures, patients remain apprehensive of contracting COVID-19 during hospitalization and recovery. We investigated symptomatic COVID-19 infection in patients undergoing operating-room procedures during the spring 2020 outbreak in Fairfield County, CT, a heavily affected New York Metropolitan area.
We retrospectively analyzed 419 operating-room patients in Danbury and Norwalk Hospitals between 3/16/20 and 5/19/20. COVID-19 infection was assessed through test results or documented well-being within 2 weeks postdischarge. Variables studied were procedure classification, length of stay, and discharge disposition. Postprocedural COVID-19 infection was analyzed using binomial tests comparing rates to state-mandated infection data.
Six patients developed COVID-19 after 212 urgent-elective and 207 emergent procedures. Overall postprocedural infection risk was equivalent to community infection risk ( > .05). No infections occurred in 1-2 day stays or urgent-elective procedures with discharge home (both < .05). Discharges home reduced the risk to one-sixth of community spread ( = .03). Risk of infection doubled in hospitalizations > 5 days ( = .05) and quadrupled in discharges to extended care facilities ( = .01).
Operating-room procedures did not increase the risk of symptomatic COVID-19 infection during an outbreak. Urgent-elective and emergent procedures during further outbreaks appear safe when anticipating short stays with discharges home. When anticipating prolonged hospitalization or discharges to facilities, appropriate delay of urgent-elective procedures may minimize risk of infection.
由于 COVID-19 大流行，手术室手术被取消，导致医院收入减少，并可能通过疾病进展导致患者预后恶化。尽管采取了恢复选择性手术的安全措施，但患者仍对在住院和康复期间感染 COVID-19 感到担忧。我们调查了康涅狄格州费尔菲尔德县 2020 年春季 COVID-19 爆发期间接受手术室手术的患者的症状性 COVID-19 感染情况，该地区是受纽约大都市影响最严重的地区之一。
我们回顾性分析了 3 月 16 日至 5 月 19 日期间在丹伯里和诺沃克医院接受手术的 419 名患者。通过测试结果或出院后 2 周内的记录健康状况评估 COVID-19 感染。研究的变量包括手术分类、住院时间和出院去向。使用二项式检验比较术后 COVID-19 感染率与州规定的感染数据，分析术后 COVID-19 感染。
212 例紧急-选择性和 207 例紧急手术中有 6 例患者在手术后出现 COVID-19。总体术后感染风险与社区感染风险相当（>.05）。1-2 天住院或出院回家的紧急-选择性手术均未发生感染（均<.05）。出院回家将感染风险降低到社区传播的六分之一（=.03）。住院时间超过 5 天的感染风险增加一倍（=.05），出院到长期护理机构的感染风险增加四倍（=.01）。
在疫情爆发期间，手术室手术并未增加出现症状性 COVID-19 感染的风险。在预期短期住院并出院回家的情况下，进一步爆发时的紧急-选择性和紧急手术似乎是安全的。在预期长时间住院或出院到设施时，适当延迟紧急-选择性手术可能会最大程度地降低感染风险。
