Khan Rehan, Zaidi Nisar, Chituku Tsitsi, Rao Milind
Upper GI Surgery, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, PR29HT, UK.
General & Colorectal Surgery, Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE219QS, UK.
Ann Med Surg (Lond). 2021 Oct;70:102617. doi: 10.1016/j.amsu.2021.102617. Epub 2021 Jul 31.
The rapid spread of the coronavirus pandemic and the associated high morbidity and mortality led to sudden lock down, forcing the elderly and others in the high risk group into isolation. Elective health care services including diagnostics, therapeutics and elective surgical services were put on hold, leading to delays seriously affecting cancer and non-cancer related services. In spite of lessons learnt during the first wave, similar issues have persisted during the second wave, increasing the pressure on an already fragile infrastructure.
Information related to surgical patients admitted since lock down (March to August 2020) as an emergency was collected on a structured proforma and analysed. Data was gathered from prospectively kept patient admission lists and Electronic Discharge summaries. All the patients who were directly or indirectly affected with poor outcomes including delayed diagnosis and treatment were identified and included in the analysis.
A total of 185 patients were admitted as an emergency during this period. Of these Eight patients admitted under surgical care were included in the study. Four out of eight patients were diagnosed with advanced cancer and the remainder presented with complications of benign pathologies. Of the four patients with advanced cancer, three patients had advanced colorectal and the fourth had advanced ovarian cancer. All four patients either presented late or had delayed access to investigations. Three out four patients with benign disease presented with complications due to cancellation of elective and semi urgent services. One patient who was COVID positive and presented with bowel perforation died after a prolonged hospital stay.
There is definite evidence of unfavourable patient outcomes in non COVID patients as a result of the COVID pandemic. As COVID is unlikely to whither down in the very near future and highs and lows are expected, rapid and safe reintroduction of elective health care services affected by COVID is the call of the hour. In addition, more efforts should be directed towards increasing awareness amongst patients regarding the importance of reporting red flag symptoms and encouraging them to access health care services.
冠状病毒大流行的迅速蔓延以及相关的高发病率和死亡率导致突然封锁，迫使老年人和其他高危人群隔离。包括诊断、治疗和择期手术服务在内的选择性医疗服务被搁置，导致严重影响癌症和非癌症相关服务的延误。尽管在第一波疫情期间吸取了教训，但类似问题在第二波疫情期间仍然存在，给本就脆弱的基础设施带来了更大压力。
收集自封锁以来（2020年3月至8月）作为急诊入院的手术患者的相关信息，并通过结构化表格进行分析。数据来自前瞻性保存的患者入院清单和电子出院小结。识别并纳入所有直接或间接受到不良结局影响（包括诊断和治疗延迟）的患者进行分析。
在此期间，共有185名患者作为急诊入院。其中，纳入研究的8名接受手术治疗的患者。8名患者中有4名被诊断为晚期癌症，其余患者表现为良性病变并发症。在4名晚期癌症患者中，3名患有晚期结直肠癌，第4名患有晚期卵巢癌。所有4名患者要么就诊延迟，要么检查延迟。4名良性疾病患者中有3名因择期和半紧急服务取消而出现并发症。1名新冠病毒检测呈阳性且出现肠穿孔的患者在长时间住院后死亡。
有明确证据表明，新冠疫情导致非新冠患者出现了不利的患者结局。由于新冠病毒在近期不太可能消失，且预计会有起伏，迅速且安全地重新引入受新冠疫情影响的选择性医疗服务是当务之急。此外，应加大力度提高患者对报告危险信号症状重要性的认识，并鼓励他们寻求医疗服务。
