Tontini Gian Eugenio, Aldinio Giovanni, Nandi Nicoletta, Rimondi Alessandro, Consonni Dario, Iavarone Massimo, Cantù Paolo, Sangiovanni Angelo, Lampertico Pietro, Vecchi Maurizio
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20100 Milan, Italy.
Department of Pathophysiology and Organ Transplantation, University of Milan, 20100 Milan, Italy.
J Clin Med. 2021 Dec 25;11(1):109. doi: 10.3390/jcm11010109.
COVID-19 pandemic has profoundly changed the activities and daily clinical scenarios, subverting organizational requirements of our Gastroenterology Units.
to evaluate the clinical needs and outcomes of the gastroenterological ward metamorphosis during the COVID-19 outbreaks in a high incidence scenario.
we compared the pertinence of gastroenterological hospitalization, modality of access, mortality rate, days of hospitalization, diagnostic and interventional procedures, age, Charlson comorbidity index, and frequency of SARS-CoV-2 infections in patients and healthcare personnel across the first and the second COVID-19 outbreaks in a COVID-free gastroenterological ward in the metropolitan area of Milan, that was hit first and hardest during the first COVID-19 outbreak since March 2020.
pertinence of gastroenterological hospitalization decreased both during the first and, to a lesser degree, the second SARS-CoV2 waves as compared to the pre-COVID era (43.6, 85.4, and 96.2%, respectively), as occurred to the admissions from domicile, while age, comorbidities, length of stay and mortality increased. Endoscopic and interventional radiology procedures declined only during the first wave. Hospitalized patients resulted positive to a SARS-CoV-2 nasopharyngeal swab in 10.2% of cases during the first COVID-19 outbreak after a median of 7 days since admission (range 1-15 days) and only 1 out of 318 patients during the second wave (6 days after admission). During the first wave, 19.5% of healthcare workers tested positive for SARS-CoV-2.
a sudden metamorphosis of the gastroenterological ward was observed during the first COVID-19 outbreak with a marked reduction in the gastroenterological pertinence at the admission, together with an increase in patients' age and multidisciplinary complexity, hospital stays, and mortality, and a substantial risk of developing a SARS-CoV-2 test positivity. This lesson paved the way for the efficiency of hospital safety protocols and admission management, which contributed to the improved outcomes recorded during the second COVID-19 wave.
新冠疫情深刻改变了医疗活动和日常临床场景，颠覆了我们消化内科的组织需求。
评估在新冠疫情高发情况下，消化内科病房转变期间的临床需求和结果。
我们比较了在米兰市区一个无新冠的消化内科病房中，第一批和第二批新冠疫情期间患者及医护人员的消化内科住院相关性、入院方式、死亡率、住院天数、诊断和介入操作、年龄、查尔森合并症指数以及新冠病毒感染频率。该病房自2020年3月以来在第一批新冠疫情中首当其冲且受影响最严重。
与新冠疫情前相比，第一批和第二批新冠疫情期间，消化内科住院的相关性均有所下降（分别为43.6%、85.4%和96.2%），居家入院情况也如此，而年龄、合并症、住院时间和死亡率有所增加。内镜检查和介入放射学操作仅在第一波疫情期间有所减少。在第一批新冠疫情期间，住院患者中有10.2%的病例在入院中位7天（范围1 - 15天）后新冠病毒鼻咽拭子检测呈阳性，第二批疫情期间318名患者中仅有1例（入院6天后）检测呈阳性。在第一波疫情期间，19.5%的医护人员新冠病毒检测呈阳性。
在第一批新冠疫情期间，观察到消化内科病房突然转变，入院时消化内科相关性显著降低，同时患者年龄、多学科复杂性、住院时间和死亡率增加，以及新冠病毒检测呈阳性的重大风险。这一经验为医院安全协议和入院管理的有效性铺平了道路，这有助于在第二批新冠疫情期间取得更好的结果。
