Department of General Surgery, Seth G.S. Medical College and K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India.
J Postgrad Med. 2021 Oct-Dec;67(4):198-204. doi: 10.4103/jpgm.JPGM_103_21.
At the onset of the first wave of COVID-19 pandemic, the publications on managing surgical emergencies were sparse. Health care personnel were facing an unprecedented problem with limited information. On this background, we have reviewed the operational challenges faced and the protocols followed by us while managing emergency surgical patients. The clinical presentations, RT-PCR testing rates, trend of COVID-19 positivity in emergency surgical patients and its comparison to the general population, swab positivity among screen positive and negative patients, grade of COVID-19 affection, the outcomes in emergency surgical patients, and COVID-19 affection in treating personnel is studied.
A protocol for triaging patients at presentation into screen positive or negative for COVID-19 was instituted. A proforma for all admitted patients over the period of March 2020 to August 2020 was maintained. A retrospective review of this data was carried out after Institutional Ethics Committee permission.
A total of 222 patients presented to the surgical emergency, of which 110 required admission. Of the admitted patients, 28 were COVID-19 positive. The positivity amongst admitted and operated patients increased to 50% and 66.67%, respectively in August. The difference in mortality rate amongst the operated COVID-19 positive (11.1%) and negative (14.28%) patients was nonsignificant. None of the treating doctors had to be quarantined during this period.
The number of COVID-19 positive patients rose serially over the study period. The outcome was not affected by the COVID-19 status in mild cases. A high rate of COVID-19 positivity was seen in patients requiring emergency surgery. Universal precautions ensured delivering treatment to emergency patients in standard time. Testing should continue for all as screening alone is not effective as the virus spreads into the population. Proper protocols helped us to protect the health care workers.
在 COVID-19 大流行的第一波疫情开始时，有关管理外科急症的文献很少。医护人员面临着信息有限的前所未有的问题。在此背景下，我们回顾了在管理急诊外科患者时面临的操作挑战和遵循的方案。研究了急诊外科患者的临床表现、RT-PCR 检测率、COVID-19 阳性率趋势及其与普通人群的比较、筛查阳性和阴性患者的拭子阳性率、COVID-19 感染程度、急诊外科患者的结局以及治疗人员中的 COVID-19 感染情况。
制定了在出现时将患者分诊为 COVID-19 筛查阳性或阴性的方案。为 2020 年 3 月至 2020 年 8 月期间的所有入院患者制定了一份表格。在获得机构伦理委员会许可后，对这些数据进行了回顾性审查。
共有 222 例患者到外科急诊就诊，其中 110 例需要入院。在入院患者中，28 例 COVID-19 阳性。8 月，住院和手术患者的阳性率分别增至 50%和 66.67%。手术 COVID-19 阳性（11.1%）和阴性（14.28%）患者的死亡率差异无统计学意义。在此期间，没有医生需要隔离。
在研究期间，COVID-19 阳性患者的数量呈连续上升趋势。在轻症患者中，COVID-19 状态对结果没有影响。需要紧急手术的患者 COVID-19 阳性率较高。普遍预防措施确保在标准时间内为急诊患者提供治疗。由于病毒在人群中传播，仅筛查效果不佳，因此应继续对所有人进行检测。适当的方案有助于保护医护人员的健康。
