Mehmet YILDIRIM, Enver İLHAN, Orhan ÜREYEN, Mehmet Burak ÖZTOP

COVİD-19 PANDEMİSİNİN GENEL CERRAHİ KLİNİĞİNDE ACİL VE ELEKTİF CERRAHİ GİRİŞİMLERE OLAN ETKİSİNİN DEĞERLENDİRİLMESİ: KESİTSEL ÇALIŞMA

AMAÇ: Covid-19 pandemisi cerrahi kliniklerinde ameliyat programlarının oluşturulmasında aksamalara neden olmuştur. Bu nedenle elektif/acil cerrahi açıdan hasta profilinde değişimler ve hastane gelirlerinde azalmaya neden olmuştur. Bu çalışma da 2020 yılının 3 aylık Covid pandemisi dönemi 2019 yılının aynı periyodu ile karşılaştırılarak gelecek dönemler için çıkarımlar sağlanması amaçlanmıştır. GEREÇ VE YÖNTEM: Eğitim ve Araştırma Hastanemizde 2019 ve 2020 yılları Mart, Nisan ve Mayıs aylarında Genel Cerrahi Kliniği’nde tedavi edilen hastalar hastane veri kayıt sisteminden çıkarılarak, demografik özellikleri, cerrahi girişimlerin tipleri, malign/benign olgular, yatış süresi, mortalite ve geri ödeme miktarları ile değerlendirildi. Çalışmanın sonuçlarında istatistik olarak nicel ve nitel değişkenin grupları arasında istatistiksel olarak anlamlı farklılık olup olmadığına bakıldı. BULGULAR: 2019 yılında 947 olgu, 2020 yılında 165 olgu ameliyat edildi. Kadın/erkek oranı 2019 ve 2020 yıllarında sırası ile 1/1.04 ve 1/1.08 bulundu. Yaş ortalaması 2019 yılı için 50.57, 2020 için 47.59 bulundu (p=0.041). 2019 yılında % 80 olan elektif ameliyat sayısı 2020 yılında %34.5 bulundu (p=0.000). Aynı dönemlerde malign/ benign oranı 1/10.9 ve 1/3.1 bulundu. Hastanede kalış süreleri ise sırasıyla 3.01 ve 5.92 gün olarak bulundu. Tedavisi şifa ile sonuçlanan hastalarda anlamlı azalma olmuştur. SONUÇ: Pandemiler programli yatışların gecikmesine neden olmakta ve hasta profilini değiştirmektedir. Bu nedenle, pandemi sürecinde elektif hastaların tedavisinin ertelenmemesi ve dolayısı ile ekonomik kaybında önüne geçilmesi için pandemi dışı hizmet verecek hastanelerin belirlenmesinin yaralı olacağını düşünmekteyiz.

EVALUATION OF THE EFFECT OF COVID-19 PANDEMIC ON EMERGENCY AND ELECTIVE SURGICAL INTERVENTIONS IN GENERAL SURGERY CLINIC: A CROSS-SECTIONAL STUDY

AIM: The Covid-19 pandemic caused disruptions in the surgery programs of the surgical clinics. For this reason, pandemic has caused changes in the patient profile and a decrease in budget income. By comparing the 3-month Covid pandemic period of 2020 with the same period of 2019, implications for future periods are aimed. MATERIAL AND METHOD: In this research,we searched the patients treated in our Training and Research Hospital in March, April and May at the 2019 and 2020. The documents were removed from the data registry system. The demographic characteristics, types of surgical procedures, malignant / benign cases, length of stay, mortality and reimbursement were examined. In the results of the study, it was examined whether there was a statistically significant difference between the groups of quantitative and qualitative variables. it was examined whether there was a statistically significant difference between the quantitative and qualitative variable groups. RESULTS: In our study, 947 cases were operated in 2019 and 165 cases in 2020. The female / male ratio was 1 / 1.04 and 1 / 1.08 in 2019 and 2020, respectively. The average age was 50.57 for 2019 and 47.59 for 2020 (p = 0.041). Elective surgery was 80% in 2019 and 34.5% in 2020 (p = 0.000). Malignant / benign ratio was found to be 1 / 10.9 and 1 / 3.1 during the same periods. The length of hospital stay was 3.01 and 5.92 days, respectively. There was a significant reduction in patients whose treatment resulted in healing. CONCLUSION: Pandemics delay scheduled hospitalizations and change the patient profile. For this reason, we think that it would be beneficial to determine the hospitals that will provide non-pandemic service in order not to delay the treatment of elective patients during the pandemic process and thus to prevent economic loss.

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1.)Squitieri LMS, Chung KC. Survivingthe COVID-19 Pandemic. Plast Reconstr Surg. 2020; 146: 437-46.
2.)Stewart A. Hospitals forfeit major revenue stream by delaying electives urgeries -5 things to know. Becker’s ASC Review 2020; 1.800.417.2035.
3.)Spolverato G, Capelli G, Restivo A, et al.The management of surgical patients during the corona virus dieases 2019 (COVID-19) pandemic. Surgery 2020; 168: 4-10.
4.)Health Management Associates (2020). COVID-19 Impact on medicaid, marketplace, and the uninsured, by State. Available at: https://www.healthmanagement.com/wp-content/uploads/HMAEstimates-of-COVID-Impact-on-Coverage-public-version-forApril-3-830-CT.pdf.
5.)Rubino F, Cohen RV, Mingrone G, et al.Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of Access to surgery. Lancet Diabetes Endocrinol. 2020; 8: 640-8.
6.)Gok AFK, Eryılmaz M, Ozmen MM, et al. Recommendations for trauma and emergency general surgery practice during COVID-19 Pandemic. Ulus Travma Acil Cerrahi Derg 2020; 26: 335-42.
7.)Gilat R, Haunschild ED, Tauro T, et al. Recommendation to optimize safety of elective surgical care while limiting the spread of COVID-19: Primum Non Nocere. Arthrosc Sports Med Rehabil. 2020;2:177-83
8.)Ellis R, Hay-David AGS, Brennan PA. Operating during the COVID-19 pandemic: How to reduce medical error. British J Oral Maxillofacial Surg. 2020; 58: 577-80.
9.)Alfano V, ErcolanoS. The efficacy of lockdown against covıd-19: a cross-country panel analysis. Appl Health Econ Health Policy. 2020; 18: 509-17.
10.)Nepogodiev D, Bhangu A. Elective surgery cancellations due to the covıd-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020; 107:1440-9
11.)Al-Shamsi HO, Alhazzani W, Alhuraiji A, et al. A Practical approach to the management of cancer patients during the novel corona virus disease 2019 (COVID-19) Pandemic: An International Collaborative Group .The Oncologist 2020; 25:e936-45.
12.)COVID Surg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An International Cohort Study. Lancet 2020; 396: 27-38.
13.)Whithford E. Pandemic hits academic hospitals hard. Inside Higher RAMA on Healthcare ED May 4, 2020. Avalible at: https:// ramaonhealthcare.com/pandemic-hits-academic-hospitals-hard/
14.)Mouton C , Hirschmann MT, Ollivier M, et al. COVID-19 - ESSKA Guidelines and recommendations for resuming elective surgery.J Exp Orthop 2020; 7: 28.
15.)Wiseman SM, Crump RT, Sutherland JM.Surgical wait list management in Canada during a pandemic: many challenges ahead. Can J Surg 2020; 63: 226-8.