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      Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie Translated title: Impact of COVID-19 on elective and emergency colorectal surgery

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          Abstract

          Hintergrund

          Die SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Pandemie hat zu weitreichenden Veränderungen in die Versorgungsrealität praktisch aller medizinischen Fachbereiche geführt.

          Ziel der Arbeit

          Empfehlungen zum perioperativen Management in Bezug auf SARS-CoV‑2 und Darstellung von Auswirkungen auf die kolorektale Chirurgie.

          Material und Methoden

          Es wurde eine systematische Literaturrecherche durchgeführt.

          Ergebnisse

          Perioperative Infektionen mit SARS-CoV‑2 führen zu einer deutlich erhöhten postoperativen Mortalität und müssen durch ein strukturiertes Maßnahmenbündel verhindert werden. Die weltweiten Einschränkungen bei Vorsorgeuntersuchungen und Therapieangeboten können mittelfristig eine erhöhte Mortalität durch kolorektale Karzinome zur Folge haben. Auch in der Notfallversorgung zeigt sich ein erheblicher Rückgang der Fallzahlen mit der Gefahr verspäteter Interventionen.

          Diskussion

          Eine rasche Normalisierung der klinischen Behandlungspfade in der Kolorektalchirurgie ist erforderlich, um langfristige negative Folgen für die Patienten zu vermeiden.

          Translated abstract

          Background

          The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to far-reaching changes in the treatment reality in practically all fields of medicine.

          Objective

          Recommendations on the perioperative management with respect to SARS-CoV‑2 and presentation of the impact of the pandemic on colorectal surgery.

          Material and methods

          A systematic literature search was carried out.

          Results

          Perioperative SARS-CoV‑2 infections lead to a clearly increased postoperative mortality and must be avoided by a structured bundle of measures. The worldwide limitations on screening investigations and treatment options can in the medium term result in an increased mortality due to colorectal cancer. In emergency treatment there was also a substantial reduction in case numbers with the danger of delayed interventions.

          Conclusion

          A rapid normalization of clinical treatment pathways in colorectal surgery is necessary to avoid long-term negative sequelae for patients.

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          Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

          Dmitri Nepogodiev, Aneel Bhangu, Savino Spadaro … (2020)
          Background The COVID‐19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID‐19. Methods A global expert‐response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian beta‐regression model was used to estimate 12‐week cancellation rates for 190 countries. Elective surgical case‐mix data, stratified by specialty and indication (cancer versus benign surgery), was determined. This case‐mix was applied to country‐level surgical volumes. The 12‐week cancellation rates were then applied to these figures to calculate total cancelled operations. Results The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID‐19 (2,367,050 operations per week). Most would be operations for benign disease (90.2%, 25,638,922/28,404,603). The overall 12‐week cancellation rate would be 72.3%. Globally, 81.7% (25,638,921/31,378,062) of benign surgery, 37.7% (2,324,069/6,162,311) of cancer surgery, and 25.4% (441,611/1,735,483) of elective Caesarean sections would be cancelled or postponed. If countries increase their normal surgical volume by 20% post‐pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID‐19 disruption. Conclusions A very large number of operations will be cancelled or postponed due to disruption caused by COVID‐19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. This article is protected by copyright. All rights reserved.
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            Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

            Amit Sud, Michael E.B. Jones, John Broggio … (2020)
            Background Cancer diagnostics and surgery have been disrupted by the response of healthcare services to the COVID-19 pandemic. Progression of cancers during delay will impact on patient long-term survival. Methods We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of three months and six months and periods of disruption of one year and two years. Using healthcare resource costing, we contextualise attributable lives saved and life-years gained from cancer surgery to equivalent volumes of COVID-19 hospitalisations. Findings Per year, 94,912 resections for major cancers result in 80,406 long-term survivors and 1,717,051 life years gained. Per-patient delay of three/six months would cause attributable death of 4,755/10,760 of these individuals with loss of 92,214/208,275 life-years. For cancer surgery, average life-years gained (LYGs) per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of three/six months (an average loss of 0.97/2.19 LYG per patient). Taking into account units of healthcare resource (HCRU), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of three/six months. For 94,912 hospital COVID-19 admissions, there are 482,022 LYGs requiring of 1,052,949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs. Interpretation Modest delays in surgery for cancer incur significant impact on survival. Delay of three/six months in surgery for incident cancers would mitigate 19%/43% of life-years gained by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59% when considering resource-adjusted life-years gained. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.
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              Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors

              Debra Patt, Lúcio Gordan, Michael Diaz … (2020)
              PURPOSE While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. METHODS This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. RESULTS In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (−74%), new patient E&M visits (−70%), and established patient E&M visits (−60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (−26%) and July (−31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. CONCLUSION The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.
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                Author and article information

                Contributors
                Armin Wiegering: wiegering_a@ukw.de
                Journal
                Journal ID (nlm-ta): Chirurg
                Journal ID (iso-abbrev): Chirurg
                Title: Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
                Publisher: Springer Medizin (Heidelberg )
                ISSN (Print): 0009-4722
                ISSN (Electronic): 1433-0385
                Publication date (Electronic): 13 July 2021
                Pages: 1-5
                Affiliations
                [1 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, , Universitätsklinikum Würzburg, ; 97080 Würzburg, Deutschland
                [2 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Comprehensive Cancer Center Mainfranken, , Universitätsklinikum Würzburg, ; Würzburg, Deutschland
                [3 ]GRID grid.8379.5, ISNI 0000 0001 1958 8658, Lehrstuhl für Biochemie und Molekularbiologie, , Biozentrum, ; Würzburg, Deutschland
                Author notes
                [Redaktion]

                C. Bruns, Köln

                Article
                Publisher ID: 1464
                DOI: 10.1007/s00104-021-01464-z
                PMC ID: 8276841
                PubMed ID: 34258647
                SO-VID: 1901896f-9947-4f84-86d5-6934cec0908d
                Copyright © © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date accepted : 22 June 2021
                Categories
                Subject: Leitthema

                Keywords: sars-cov‑2,pandemie,appendizitis,kolorektales karzinom,vorsorge,pandemic,colorectal cancer,appendicitis,cancer screening
                Data availability:
                Keywords: sars-cov‑2, pandemie, appendizitis, kolorektales karzinom, vorsorge, pandemic, colorectal cancer, appendicitis, cancer screening

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