Surgery Care Research Articles

Variation in resource utilization and mortality among patients with varying MR type and severity

Limited data exists regarding the relationships between resource use and outcomes in patients with mitral regurgitation (MR). We examined resource utilization and outcomes across MR type and severity. Using the Duke Echocardiography Laboratory Database, we identified patients with an index echo demonstrating moderate or severe MR (2000-2016) and examined 5-year cumulative rates of resources (ie, TTE, TEE, cardiac catheterization, cardiology/CTS referral, MV surgery/TEER, hospitalizations) by severity and type. We performed a multivariable landmark analysis of resource use during a 6 to 12 month period and 5-year mortality; and a multivariable analysis of the association between MR type and 5-year hospitalization costs. Among 4,511 patients with moderate or severe MR, 84.7% had moderate MR and 42.2% had secondary ischemic MR. The median age was 70 years-moderate, 66 years-severe. The mean 5-year cumulative resource utilization rate was 11.1 encounters/patients. Among patients with moderate or severe MR, there was significant variation in utilization of each resource by MR type (all P < .05). For severe MR, the performance of cardiac catheterization or MV surgery during the landmark period was associated with significantly lower mortality; for moderate MR, CTS referral during the landmark was associated with significantly lower mortality (P < .05). Patients with secondary ischemic and non-ischemic MR had significantly higher 5-year hospitalization costs compared with primary myxomatous MR (P < .05). Resource utilization and outcomes vary by MR type and severity. Utilization of resources, such as TTE, during guideline-recommended surveillance periods was not associated with a reduction in mortality while other care (catheterization or surgery) was associated with improved survival.

Trauma financials: Does anyone really know?

Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare Conflict of Interest: None Sources of Funding: None Samir M. Fakhry MD, FACS, Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare 2515 Park Plaza, Bldg 2-3W Nashville, TN 37203. [email protected], ORCID: 0000-0002-6781-0863

Genital tract infection and pelvic surgery contribute to the development of endometriosis

Endometriosis is a multifactorial disease, and inflammation is considered a core pathology. Inflammation related to genital tract infection (GTI) and surgical injury may cause endometriosis. Therefore, we investigated the incidence of endometriosis in women with a recent history of GTI, pelvic surgery, or both. Using the Korean National Health Insurance Service-National Sample Cohort, 20- to 49-year-old women diagnosed with GTI or who underwent pelvic surgeries between 2002 and 2008 were collected and followed up for five years. After excluding women who had already been diagnosed with endometriosis or diseases that may affect endometriosis, a total of 30,336 women were diagnosed with GTI (Study 1), 2894 women who underwent pelvic surgery (Study 2), and 788 women who underwent GTI and pelvic surgery, both (Study 3) were enrolled for each study. The comparison groups in which sociodemographic factors matched for each group were collected. The incidence of endometriosis per 1000 person-year was 5.37, 5.17, and 20.81 in each case group and was significantly higher than each comparison group. A recent history of GTI increased an adjusted hazard ratio (aHR) of 2.29 (1.99–2.63, 95% confidence interval) for the development of endometriosis. The aHRs of pelvic surgery history and the history of both GTI and pelvic surgery were 2.10 and 7.82, respectively. In conclusion, the pelvic inflammation resulting from genital infection and pelvic surgical injury may play a role in developing endometriosis. Active treatment of genital infections and careful surgical procedures to minimize tissue injury may reduce the incidence of pelvic endometriosis.

Quality of recovery after day care surgery with app-controlled remote monitoring: study protocol for a randomized controlled trial

BackgroundThe majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at home after day care surgery might improve patient’s recovery. Currently patient experiences with smartphone applications are promising; however, we do not know whether remote monitoring with such an application also improves the patient’s recovery. This study aims to evaluate the experienced quality of recovery after day care surgery between patients provided with the smartphone application for remote monitoring and patients receiving standard care without remote monitoring.MethodsThis non-blinded randomized controlled trial with mixed methods design will include 310 adult patients scheduled for day care surgery.The intervention group receives the smartphone application with text message function for remote monitoring that enables patients to record pain and nausea. An anaesthesia professional trained in empathetic communication, who will contact the patient in case of severe pain or nausea, performs daily monitoring. The control group receives standard care, with post-discharge verbal and paper instructions.The main study endpoint is the difference in perceived quality of recovery, measured with the QoR-15 questionnaire on the 7th day after day care surgery. Secondary endpoints are the overall score on the Quality of Recovery-15 at day 1, 4 and 7-post discharge, the perceived quality of hospital aftercare and experienced psychological effects of remote monitoring during postoperative recovery from day care surgery.DiscussionThis study will investigate if facilitating patients and healthcare professionals with a tool for accessible and empathetic communication might lead to an improved quality of the postoperative recovery period.Trial registrationThe ‘Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial’ is approved and registered on 23 February 2022 by Research Ethics Committees United with registration number R21.076/NL78144.100.21. The protocol NL78144.100.21, ‘Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial’, is registered at the ClinicalTrials.gov public website (registration date 16 February 2022; NCT05244772)

The next frontier of acute care general surgery: fellowship training.

SummaryAcute care surgery (ACS) is an area of surgical specialization within general surgery and a model for clinical care delivery that has proliferated over the last 2 decades. Models of ACS in Canada exist in both academic and community settings and are used to manage patients in need of emergency general surgery (EGS) care, with or without the provision of trauma care. The implementation of the ACS model has changed the landscape of patient care, surgical education and the workforce, providing an option for some general surgeons to exclude EGS care from their regular practice. The rise of ACS as a concentration of surgical skill and content expertise has resulted in the establishment of dedicated ACS fellowship training programs. This is a landmark in the evolution of general surgery, as well as a stepping stone on the path to improving patient care, surgical education and scholarly endeavour in this field.

Insurance "churn": Is trauma a special flavor?

Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare Conflict of Interest: None Sources of Funding: None Samir M. Fakhry MD, FACS, Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare 2515 Park Plaza, Bldg 2-3W Nashville, TN 37203. [email protected], ORCID: 0000-0002-6781-0863

Low Morbidity and Mortality in Children with Severe Traumatic Brain Injury Treated According to the Lund Concept: A Population-Based Study.

Previous reports of mortality and morbidity in pediatric severe traumatic brain injury (TBI) vary considerably, with few population-based studies. Mortality rates from 3-33 % and varying morbidity have been reported, most commonly using the Extended Glasgow Outcome Scale (eGOS). The Lund concept is a treatment algorithm for severe TBI aiming at controlling intracranial pressure (ICP) by reducing cerebral perfusion pressure (CPP). The aim of the present study was to retrospectively assess mortality and morbidity in a population of pediatric TBI treated according to the Lund concept. All cases of severe pediatric TBI (age <18 years) in the southern region of Sweden during 19 years were identified. Patients were treated according to the Lund concept. Mortality, eGOS, ICP, CPP, time in the neurosurgical intensive care unit (NICU), drugs delivered and surgical procedures were recorded. Data were analyzed both by dichotomized outcomes and by ordinal statistics. A total of 135 cases of severe TBI <18 years of age were recorded (incidence 2.0/100000) and 86 patients were admitted to the tertiary NICU. Mortality including all cases was 43% (mortality rate 0.7/100,000) and in NICU 10%. Outcome was good in 60%, moderate in 25%, unfavorable in 15%, with none in a vegetative status. In both dichotomized and ordinal analyses, CPP <40 mm Hg and ICP >15 were associated with poor outcome, supporting current guidelines. However, high CPP also was associated with increased mortality and morbidity, supporting that elevated CPP might increase cerebral edema. In this study, the Lund concept resulted in low mortality and a favorable outcome in a majority of severe pediatric TBI patients; however, randomized controlled trials are warranted to verify this.

Sleep Deprivation, Burnout, and Acute Care Surgery.

To define what sleep deprivation is, how it relates to the growing problem of burnout within surgeons, and what can be done to mitigate its effects. There is a growing awareness that sleep deprivation, in both its acute and chronic manifestations, plays an immense role in burnout. The physical and mental manifestations of sleep deprivation are manifold, effecting nearly every physiologic system. Studies evaluating strategies at mitigating the effects of sleep deprivation are promising, including work done with napping, stimulant use, and service restructuring, but are fundamentally limited by generalizability, scale, and scope. The overwhelming majority of data published on sleep deprivation is limited by size, scope, and generalizability. Within acute care surgery, there is a dearth of studies that adequately define and describe sleep deprivation as it pertains to high-performance professions. Given the growing issue of burnout amongst surgeons paired with a growing patient population that is older and more complex, strategies to combat sleep deprivation are paramount for surgeon retention and wellbeing.

Surgical resident operative autonomy on nights and weekends: What happens to surgical education during off-hours?

Surgical resident operative autonomy is critical for trainee maturation to independence. Acute care surgery (ACS) cases commonly occur off-hours and tension between operating room availability and on-call staff can affect resident operative autonomy. We examined operative resident autonomy for general, vascular, and thoracic (GVT) surgery during nights and weekends. We hypothesized that residents would be afforded less operative autonomy during off - hours than weekdays. This retrospective cohort study uses the Veterans Affairs Surgical Quality Improvement Program database, we examined all GVT cases at Veterans Affairs teaching hospitals from 2004 to 2019. All cases are coded for the level of supervision at the time of surgery: AP, attending primary surgeon; AR, attending and resident operating together; and RP, resident primary (attending supervising but not scrubbed). Cases starting between 6 pm to 7 am Monday through Friday were considered nights, cases on Saturday/Sunday were considered weekends, and collectively considered "off-hours." Resident primary case rates were compared by start time and type. Over the 15-year study period, there were 666,421 GVT cases performed with 38,097 cases (6%) performed off-hours. During off-hours, 31,396 (83%) were ACS compared with 5% of daytime cases. Overall, off-hours cases have higher RP rate than daytime cases (6.8% vs. 5.8%, p < 0.001). Daytime ACS cases have higher rates of RP than nights/weekends (7.6% vs. 6.8%, p < 0.001). Conversely, daytime elective cases have lower RP than nights (5.7% vs. 7.9%, p < 0.001). During off-hours, there are more RP cases on nights compared with weekends (7.1% vs. 6.5%, p = 0.02). Overall, residents were afforded more operative autonomy during off-hours, with nights having greater RP than weekends. In contrast, ACS cases have more autonomy during weekdays. These data have potentially significant implications for ACS service staffing, night float rotations, and overall resident operative experience on ACS services. Prognostic and Epidemiological; Level III.

Smart Healthcare Applications over 5G Networks: A Systematic Review

Provisioning of health services such as care, monitoring, and remote surgery is being improved thanks to fifth-generation cellular technology (5G). As 5G expands globally, more smart healthcare applications have been developed due to its extensive eMBB (Enhanced Mobile Broadband) and URLLC (Ultra-Reliable Low Latency Communications) features that can be used to generate healthcare systems that allow minimizing the face-to-face assistance of patients at hospital centers. This powerful network provides high transmission speeds, ultra-low latency, and a network capacity greater than that of 4G. Fifth-generation cellular technology is expected to be a means to provide excellent quality of medical care, through its technological provision to the use of IoMT (Internet of Medical Things) devices. Due to the numerous contributions in research on this topic, it is necessary to develop a review that provides an orderly perspective on research trends and niches for researchers to use as a starting point for their work. In this context, this article presents a systematic review based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), with article selection based on inclusion and exclusion criteria that avoid bias. This research was based on research questions that were answered from the included works. These questions focus on technical characteristics, health benefits, and security protocols necessary for the development of smart healthcare applications. We have identified that a high percentage of existing works in the literature are proposals (56.81%, n = 25) and theoretical studies (22.73%, n = 10); few implementations (15.91%, n = 7) and prototypes (4.55%, n = 2) exist, due to the limited global deployment of 5G. However, the panorama looks promising based on proposals and future work that these technological systems allow, all based on improving healthcare for people.

Patient-specific Composite Anatomic Models: Improving the Foundation for Craniosynostosis Repair.

Preoperative surgical planning incorporating computer-aided design and manufacturing is increasingly being utilized today within the fields of craniomaxillofacial, orthopedic, and neurosurgery. Application of these techniques for craniosynostosis reconstruction can include patient-specific anatomic reference models, "normal" reference models or patient-specific cutting/marking guides based on the presurgical plan. The major challenge remains the lack of tangible means to transfer the preoperative plan to the operating table. We propose a simple solution to utilize a digitally designed, 3D-printed "composite model" as a structural template for cranial vault reconstruction. The composite model is generated by merging the abnormal patient cranial anatomy with the "dural surface topography" of an age-matched, sex-matched, and ethnicity-matched normative skull model. We illustrate the applicability of this approach in 2 divergent cases: 22-month-old African American male with sagittal synostosis and 5-month-old White male with metopic synostosis. The aim of this technical report is to describe our application of this computer-aided design and modeling workflow for the creation of practical 3D-printed skulls that can serve as intraoperative frameworks for the correction of craniosynostosis. With success in our first 2 cases, we believe this approach of a composite model is another step in reducing our reliance on subjective guesswork, and the fundamental aspect of the workflow has a wider application within the field of craniofacial surgery for both clinical patient care and education.

Learning deep architectures for the interpretation of first-trimester fetal echocardiography (LIFE) - a study protocol for developing an automated intelligent decision support system for early fetal echocardiography

BackgroundCongenital Heart Disease represents the most frequent fetal malformation. The lack of prenatal identification of congenital heart defects can have adverse consequences for the neonate, while a correct prenatal diagnosis of specific cardiac anomalies improves neonatal care neurologic and surgery outcomes. Sonographers perform prenatal diagnosis manually during the first or second-trimester scan, but the reported detection rates are low. This project’s primary objective is to develop an Intelligent Decision Support System that uses two-dimensional video files of cardiac sweeps obtained during the standard first-trimester fetal echocardiography (FE) to signal the presence/absence of previously learned key features.MethodsThe cross-sectional study will be divided into a training part of the machine learning approaches and the testing phase on previously unseen frames and eventually on actual video scans.Pregnant women in their 12–13 + 6 weeks of gestation admitted for routine first-trimester anomaly scan will be consecutively included in a two-year study, depending on the availability of the experienced sonographers in early fetal cardiac imaging involved in this research.The Data Science / IT department (DSIT) will process the key planes identified by the sonographers in the two- dimensional heart cine loop sweeps: four-chamber view, left and right ventricular outflow tracts, three vessels, and trachea view. The frames will be grouped into the classes representing the plane views, and then different state-of-the- art deep-learning (DL) pre-trained algorithms will be tested on the data set. The sonographers will validate all the intermediary findings at the frame level and the meaningfulness of the video labeling.DiscussionFE is feasible and efficient during the first trimester. Still, the continuous training process is impaired by the lack of specialists or their limited availability. Therefore, in our study design, the sonographer benefits from a second opinion provided by the developed software, which may be very helpful, especially if a more experienced colleague is unavailable. In addition, the software may be implemented on the ultrasound device so that the process could take place during the live examination.Trial registrationThe study is registered under the name „Learning deep architectures for the Interpretation of Fetal Echocardiography (LIFE)”, project number 408PED/2020, project code PN-III-P2–2.1-PED-2019. Trial registration: ClinicalTrials.gov, unique identifying number NCT05090306, date of registration 30.10.2020.

Comparison of different scoring systems in predicting mortality and postoperative complications in acute care surgery patients at a Saudi Academic Centre.

Emergency surgery carries an increased risk of death and complications. Scoring systems can help identify patients at higher risk of mortality and complications. Scoring systems can also help benchmark acute care services. This study aims to compare different scoring systems in predicting outcomes among acute care surgery patients. Our study is a retrospective cohort study that included all adult emergency surgery admissions between 2017 and 2019. Data were obtained from patients' electronic health records. Same admission mortality and postoperative complications were collected. Data were recorded to calculate the American Society of Anesthesiologists Physical Status classification system (ASA-PS), Shock Index Score (SI), Age Shock Index Score (AgeSI), and the Emergency Surgery Score (ESS). The probability of death and complications was correlated with each scoring system and was assessed by calculating the c-statistic. During the study period, 1606 patients fulfilled inclusion criteria. The mortality rate was 2.2%, complication rate was 18.7%. ESS predicted mortality with a c-statistic of 0.87 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.81, 0.74, and 0.57, respectively. ESS also predicted the occurrence of complications with a c-statistic of 0.83 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.72, 0.71, and 0.63, respectively. ESS demonstrated a better prognostic accuracy for hospital mortality and postoperative complications than other prognostic scoring systems. Our findings suggest that a scoring system designed for the acute care surgical population may provide enhanced prognostic performance over other surgical prognostic scoring systems.

Sex-Based Differences in Survival Among Patients with Acute Abdomen Undergoing Surgery in Malawi: A Propensity Weighted Analysis.

Sex disparities in access to health care in low-resource settings have been demonstrated. Still, there has been little research on the effect of sex on postoperative outcomes. We evaluated the relationship between sex and mortality after emergency abdominal surgery. We performed a retrospective cohort study using the acute care surgery database at Kamuzu Central Hospital (KCH) in Malawi. We included patients who underwent emergency abdominal surgery between 2013 and 2021. We created a propensity score weighted Cox proportional hazards model to assess the relationship between sex and inpatient survival. We included 2052 patients in the study, and 76% were males. The most common admission diagnosis in both groups was bowel obstruction. Females had a higher admission shock index than males (0.91 vs. 0.81, p < 0.001) and a longer delay from admission until surgery (1.47 vs. 0.79days, p < 0.001). Females and males had similar crude postoperative mortality (16.3% vs. 15.3%, p = 0.621). The final Cox proportional hazards regression model was based on the propensity-weighted cohort. The mortality hazard ratio was 0.65 among females compared to males (95% CI 0.46-0.92, p = 0.014). Our results show a survival advantage among female patients undergoing emergency abdominal surgery despite sex-based disparities in access to surgical care that favors males. Further research is needed to understand the mechanisms underlying these findings.

Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

BackgroundSevere traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care.MethodsA multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted.ResultsA total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided.ConclusionsThis consensus provides practical recommendations to support clinician’s decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.

Treatment dependent impact of plasma-derived exosomes from head and neck cancer patients on the epithelial-to-mesenchymal transition.

Epithelial to mesenchymal transition (EMT) is a key process in carcinogenesis of head and neck squamous cell carcinoma (HNSCC), contributing to tumor invasiveness, distant metastasis, and recurrence. Exosomes are known mediators and regulators of EMT. Here, we analyze the impact of exosomes that were primed by conventional therapy on EMT modulation. Plasmas of n = 22 HNSCC patients were collected before and after standard of care surgery and adjuvant or primary (chemo)radiotherapy. Exosomes were isolated by size exclusion chromatography. Upon co-incubation of exosomes with HNSCC cells, the cellular EMT profile was analyzed by flow cytometry and RT-qPCR. Wound healing assays were performed to evaluate migratory potential of exosome-treated cells. Reduction of total exosome protein after therapy and in vitro exosome induced EMT profiles were dependent on the type of treatment. Exosomal TFG-β and miRNA cargo were partly responsible for observed exosome induced EMT changes. Exosomes from recurrent patients induced higher tumor cell migration after therapy than exosomes from disease-free patients. HNSCC patients' exosomes from timepoints before and after therapy were able to confer therapy induced EMT modulation in vitro and have the potential to monitor the EMT process. Exosome induced changes in migratory potential emerged as discriminants of therapy outcome.

Comparison of Chloroprocaine and Bupivacaine for Spinal Anaesthesia in Patients Undergoing Day Care Surgery: A Double Blind Randomized Controlled Study

Background:In the last few years, the number of surgical procedures performed on day care basis has increasedworldwide, nearly between 20% - 30% surgeries are being performed as outpatient procedures. Ambulatorysurgery has become increasingly popular due to advantages for the individual patient and the positive economicimpact for the health care system. In the near future, ambulatory surgery is likely to expand further.Objectives: The objectives of this study were to compare chloroprocaine and bupivacaine for spinal anaesthesia inpatients undergoing day care surgery.Methods: Patients between 18-60 years’ age of either sex, belonging to ASA I and ASA II undergoing day caresurgeries lasting 45-60 min were included in this study after approval of Institutional Review Board and obtaininginformed consent. Preanaesthetic check-up was done one day before surgery patients were evaluated for anysystemic diseases and laboratory investigation recorded the procedure of spinal anaesthesia was explained tothe patients and written informed consents was obtained. Hundred patients were randomly divided into twogroups of fifty each. Fifty patients received 0.5% heavy 10mg (2cc) bupivacaine. Fifty patients received 40mg (4cc)preservative free 2-chloroprocaine. The primary outcome of this study, I. e., the time to eligibility for dischargefrom hospital, was measured from the time spinal anaesthesia was performed to the time the patient attained allof the discharge criteria.Results : Intrathecal 1% 2-chloroprocaine 40 mg provides spinal anaesthesia of adequate duration for day caresurgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier ambulationand earlier voiding with stable hemodynamic as compared to 0.5% hyperbaric bupivacaine 10 mg.&#x0D; Conclusion: Thus we conclude that 2-chloroprocaine can provide spinal anaesthesia with a shorter recoveryprofile than bupivacaine, permitting earlier discharge from hospital after day care surgeries

Feasibility and safety of pyeloplasty as day care surgery in pediatric patients: Initial experience.

Objective: To share experience feasibility and safety of pyeloplasty as day care procedure in pediatric patients. Study Design: Prospective Quasi Experimental study. Setting: Department of Urology, Saidu Teaching Hospital, Swat. Period: 1st July 2018 to 31st March 2020. Material &amp; Methods: Pediatric patients presented with complaints of pelviureteric junction obstruction (PUJO) were carefully selected for day care pyeloplasty. They were electively admitted on the same day and operated in the morning hours and discharged after check by the operating surgeon if they fulfill criteria for day care surgery. Results: A total of 82 patients were planned for pyeloplasty 86.16% patients selected for day care surgery and discharged within 12 hours while 13% patients were admitted for 24 hour or more. Among day care patients 4.2% were readmitted for social reasons, 2.8 % patients had fever and admitted to in patient facility for intravenous antibiotics. 1.4% patients readmitted for gross hematuria and managed conservatively , 4.2% patient were complaining of pain and adjusted pain medication on outpatient basis and 4.2% patients had telephonic contact for stent symptoms and were reassured. Conclusion: Day care pyeloplasty is safe and cost effective procedure in careful selected pediatric patients who were complaining of symptoms due to PUJO.

Pudov Surgical care in a multi-field hospital during the new coronavirus infection pandemic (SARS-COVID-19): a 5-year experience

To analyze the 5-year experience of surgical care in a multi-field hospital during the coronavirus pandemic and before infection. We assessed «non-traumatic» surgery and the main indicators in a multi-field hospital during the coronavirus pandemic and surgical work in the «pre-COVID» period. The number of discharged patients was the same between 2018 and 2021. In 2020-2021, mortality increased by 2.8 times, the number of deceased patients - by 2.5 times, hospitalizations for emergency surgical indications - by 2.1 times. Elective care decreased by 2.5 times. The number of adverse vascular events increased by 3 times. Acute increase in emergency surgery and decrease in elective care create the prerequisites for growth of «neglect» with subsequent postoperative complications. We observed significant increase in mortality. It is advisable to create a backup emergency surgical service in infectious disease hospitals to provide care in obviously infected patients.

Acute care surgery model in the COVID-19 pandemic era.

Acute care surgery model in the COVID-19 pandemic era.