COVID-19 salgýný altýnda genel cerrahi uygulamalarý: Ýstanbul’da bir salgýn hastanesinin deneyimi

AMAÇ: Pandemi sürecinde genel cerrahi kliniklerinde elektif operasyonlar ertelense de acil travma, akut karýn ve kanser ameliyatlarý gibi ertelenemeyen operasyonlara devam edildi. Çalýþmamýzda salgýn süresince hastanemiz genel cerrahi kliniðinde ameliyat edilen acil ve ertelenemeyen elektif olgularý sunmayý, pandemi sýrasýnda bu hastalara müdahale eden saðlýk çalýþanlarý için asýl risk oluþturan genel cerrahi hasta grubunu belirlemeyi ve benzer bir durum yaþanma olasýlýðý için tecrübemizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþma geriye dönük bir kohort çalýþmasý olarak tasarlanmýþtýr. 10 Mart–23 Mayýs 2020 tarihleri arasýnda Ýstanbul Kartal Dr. Lütfi Kýrdar Þehir Hastanesi’ne baþvuran acil ve ertelenemeyen elektif ameliyata alýnan hastalar çalýþmaya dahil edildi. Hastalar ameliyat öncesi SARS-CoV-2 enfeksiyonu açýsýndan test edildi. Taburculuk sonrasý da pansuman ve poliklinik takiplerinde rutin olarak ateþ ve COVID-19 semptomlarý açýsýndan kontrollerine devam edildi. Ayrýca ulusal saðlýk takip sisteminden (e-nabýz) taburculuk sonrasý ilk 15 günde COVID-19 tanýsý alýp almadýðý kontrol edildi. Taburculuk sonrasý ilk on beþ günde COVID-19 sürüntüsü (RT-PCR) pozitif olan ya da çekilen toraks tomografisinde infiltrasyonu olan hastalar hastane bulaþý açýsýndan þüpheli kabul edildi.
BULGULAR: 10 Mart–23 Mayýs 2020 tarihleri arasýnda COVID-19 salgýný süresince çalýþmamýzda toplam 195 hasta ameliyat edildi. Bunlarýn 96’sý (%49.2) acil, 99’u (%50.8) ertelenemez elektif ameliyatlardý. Baþvuru esnasýnda hastalarýn 13’üne COVID-19 sürüntü (RT-PCR) ve toraks tomografi bulgularý ile COVID-19 tanýsý konuldu. Covid(+) ameliyat olan hasta grubunun büyük bir kýsmýnýn (n=12, %92.3) acil nedenlerden ameliyat olduðu görüldü. Covid(+) grupta ameliyat sonrasý birinci gün üç hastada mortalite saptandý. Mortalite oranlarý Covid(+) hastalarda istatistiksel olarak daha yüksekti (n=3, 23.1% ve n=8, 4.4%). Çalýþma süresince kliniðimizdeki hiçbir saðlýk çalýþanýnda COVID-19 semptomu saptanmadý. Elektif ameliyat olan 3 hastada ise hastane yatýþ ve taburculuk sonrasý takiplerinde COVID-19 pozitifliði saptandý.
TARTIÞMA: Bu zor zamanlarda ameliyatlarýn sürmesi saðlýk sistemimizin önemli bir yönü olmaya devam edecektir. Sonuçlarýmýzýn hastane içi hastalýk yayýlýmýnýn azalmasýnda, saðlýk personeline bulaþýn engellenmesinde ve cerrahi ekibin hangi hasta grubunda yüksek risk altýnda olacaklarýný bilmelerinde faydalý olacaðýna inanýyoruz.

General surgery practice under the COVID-19 pandemic: The experience of a pandemic hospital in Istanbul

BACKGROUND: Although elective operations in general surgery clinics were postponed during the pandemic, non-deferrable operations such as emergency trauma, acute abdominal, and cancer surgeries continued. We aimed to present emergency and non-deferrable elective surgery cases in our hospital’s general surgery clinic during the pandemic, to identify the general surgery patients that pose the greatest risk for healthcare workers who served these patients, and to share our experience in these situations.
METHODS: The study was designed as a retrospective cohort study. The study included patients admitted for emergency and non-deferrable elective surgeries in Kartal Dr. Lutfi Kirdar City Hospital in Istanbul between March 10, 2020, and May 23, 2020. The patients were tested before the operation for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection. They were also routinely checked for fever and coronavirus disease 2019 (COVID-19) symptoms during dressing changes and outpatient follow-up visits after discharge as well as through the national health monitoring system (e-nabýz) whether the patients were diagnosed with COVID-19 within the 15 days of discharge. Patients who tested positive in the reverse transcription-polymerase chain reaction (RT-PCR) tests in the first 15 days after discharge or had infiltration in thorax tomography were considered suspicious in terms of hospital transmission.
RESULTS: During the COVID-19 pandemic period between March 10, 2020, and May 23, 2020, a total of 195 patients were operated on. Of these, 96 (49.2%) were operated due to emergencies, and 99 (50.8%) were non-deferrable elective surgeries. At the time of admission, 13 patients were diagnosed with COVID-19 through RT-PCR and thorax tomography findings. A higher proportion of the patients with COVID-19 (n=12, 92.3%) were found to be operated for emergencies. Three patients with COVID-19 died on the 1st postoperative day. Mortality was significantly higher in this group than in those who tested negative (n=3, 23.1% vs. n=8, 4.4%). During the study, none of the healthcare workers in our clinic developed COVID-19 symptoms. Three patients who had elective surgery were found to be SARS-CoV-2 (+) in the follow-up period after discharge.
CONCLUSION: Maintaining functional surgery departments under challenging times, such as a pandemic, will continue to be an important aspect of health systems. We believe that the results of this study will help reduce in-hospital transmission, help prevent disease transmission to healthcare personnel, and allow the members of the surgical teams to know in which patient group they will be at higher risk of infection during the operation.