Surgery in the Time of COVID-19 Pandemic

The ongoing coronavirus disease 2019 (COVID-19) which started in China, was declared on the 11th of March as a global pandemic 2020 by the World Health Organization (WHO).

Governments around the world have introduced differing forms of lock downs since the start of the pandemic demanding citizens to confine to their homes and go out only in necessity to minimize exposure to the virus. The response was observed in the emergency departments and the number of patients who presented for non-Covid issues drastically reduced.

Hospitals activated their mass casualty management plans and have reorganized and overstretched their capacity to be able to absorb both the influx of patients with the virus and those with other conditions.

Part of that reorganization was reducing the surgical activity. The main focus was shifted to patients who are considered urgent and elective surgery were postponed. Hence only surgical emergencies were maintained. Many did not present to the emergency department for fear to contract the virus and from a sense of national and global solidarity against that pandemic.

Whereas these measures are essential to prevent the spread of the virus, it may be hypothesized that for non-Covid issues, including surgical emergencies, patients may present late to the emergency department due to fear of contracting the infection in hospital. This would delay their management and lead to a worsened symptomology on presentation requiring a more complex surgical intervention with an increased complication profile.

The investigators present initial data from four major hospitals in Belgium, characterizing surgical emergencies that were managed since the start of the pandemic and discuss the repercussion the pandemic has on management of urgent surgical patients and most likely evolution of surgery after the pandemic.

Study Overview

• Status: Completed
• Conditions: Covid19
• Intervention / Treatment: Other: Data extraction from medical files

• Study Type: Observational
• Enrollment (Actual): 707

Contacts and Locations

Study Locations

• Belgium
  • Brussel, Belgium, 1090
    • UZ Brussel
  • Brussels, Belgium, 1020
    • CHU Brugmann
  • Brussels, Belgium, 1070
    • Erasme
  • Brussels, Belgium, 1000
    • St Pierre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All the patient that have benefited of a surgical intervention since the start of the COVID19 pandemic in Belgium and specifically the 16 th of March 2020 (lock down) to 12 of april 2020. The involved hospitals are: Brugmann hospital, UZ Brussel Hospital, Erasme Hospital and Saint Pierre Hospital.

Description

Inclusion Criteria:

Patients who had a surgical procedure since the start of the lock down in Belgium due to the COVID19 pandemic (16 of March 2020 to the 12 of April 2020).

Exclusion Criteria:

None

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Surgical intervention; Patients who had a surgical procedure since the start of the lockdown in Belgium due to the COVID19 pandemic (16 of March 2020 to the 12 of April 2020.	Other: Data extraction from medical files; Data extraction from medical files

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Surgery code	Type of surgery as defined by the surgery code	5 minutes
Urgency	Degree of urgency of the surgery	5 minutes
Type of anesthesia	Type of anesthesia	5 minutes
Delay between surgery and first symptoms	Delay between surgery and first symptoms	5 minutes
Surgery duration	Surgery duration (anesthesia included)	5 minutes
Hospital stay (in days)	Hospital stay (in days)	5 minutes
Intensive care unit stay (in days)	Intensive care unit stay (in days)	5 minutes
Post-op complications	Post-op complications	5 minutes
Covid status before surgery	Covid status before surgery (positive=1, negative=0 )	5 minutes
Covid status post-surgery	Covid status post-op (positive=1, negative=0 )	5 minutes
COVID19 Diagnosis by CT scan	COVID19 Diagnosis confirmed by CT scan of the thorax (Yes=1, No=0)	5 minutes
COVID19 Diagnosis by swab test	COVID19 Diagnosis by swab test (Yes=1, No=0)	5 minutes
COVID 19 Diagnosis by antibody test	COVID 19 Diagnosis by antibody test (Yes=1, No=0)	5 minutes
COVID19 symptoms - dry cough	dry cough (Yes=1, No=0)	5 minutes
COVID19 symptoms - fever	fever (Yes=1, No=0)	5 minutes
COVID19 symptoms - myalgia	myalgia (Yes=1, No=0)	5 minutes
COVID19 symptoms - anosmia	anosmia (Yes=1, No=0)	5 minutes
COVID19 symptoms -respiratory distress	respiratory distress (Yes=1, No=0)	5 minutes
Treatment for COVID19 - Plaquenil	Plaquenil (Yes=1, No=0)	5 minutes
Treatment for COVID19 - Antivirals	Antivirals (Yes=1, No=0)	5 minutes
Need for intubation	Need for intubation (Yes=1, No=0)	5 minutes
Death	Mortality (Yes=1, No=0)	5 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age	Patient age	5 minutes
Gender	Patient gender	5 minutes
Ethnicity	Patient ethnicity	5 minutes
BMI	Patient Body Mass Index	5 minutes
Comorbidities	Patient comorbidities	5 minutes

Collaborators and Investigators

• Sponsor: Brugmann University Hospital
• Investigators: Study Director: Yasser Farid, CHU Brugmann

Study record dates

Study Major Dates

• Study Start (ACTUAL): April 14, 2020
• Primary Completion (ACTUAL): March 15, 2021
• Study Completion (ACTUAL): March 15, 2021

Study Registration Dates

• First Submitted: December 23, 2020
• First Submitted That Met QC Criteria: December 23, 2020
• First Posted (ACTUAL): December 24, 2020

Study Record Updates

• Last Update Posted (ACTUAL): March 16, 2021
• Last Update Submitted That Met QC Criteria: March 15, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: CHUB-Farid

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No