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Original article
SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital
Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirugía General y del Aparato Digestivo en un hospital terciario
Mario Álvarez Gallego, Sara Gortázar de las Casas, Isabel Pascual Migueláñez
Corresponding author
isabelpasmi@hotmail.com

Corresponding author.
, Inés Rubio-Pérez, Cristina Barragán Serrano, Estíbaliz Álvarez Peña, Joaquín Díaz Domínguez
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
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it has been necessary to adapt the work activities of other hospital departments&#44; such as General Surgery and their staff&#44; to the common goal of treating these patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">SARS-CoV-2 infection among the population of the Community of Madrid developed rapidly after the detection of the first case imported from Italy in late February 2020&#46; Despite the measures that were gradually adopted&#44; both regionally as well as nationally&#44; the number of cases continues to increase to this day&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first case of SARS-CoV-2 infection was detected in Madrid on February 24&#44; 2020&#46; The patient was a young male who had returned from a trip through northern Italy&#46; After March 8th&#44; the growth of COVID-19 cases increased sharply&#44; and on March 9th the Government of the Community of Madrid announced the first measures to prevent the propagation of the virus among the population&#58; cancellation of classes at all educational levels for 2 weeks&#44; as well as the possibility of cancellation or delay of medical consultations&#44; diagnostic testing and non-essential surgeries&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Parallel with the progressive increase in cases in the general population and the increase in consultations in the Emergency Department due to respiratory conditions and symptoms compatible with COVID-19&#44; we also began to see patients in the General Surgery Department with suspected SARS-CoV-2 infection&#44; and the first cases of infection were detected among surgeons of the department&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This study provides a descriptive analysis of the impact that the SARS-CoV-2 pandemic has had in a General and Gastrointestinal Surgery Department at a tertiary hospital in Madrid &#40;Spain&#41; during the first weeks of spread of the disease among its population&#46; The objective is to analyze the incidence of cases of patients and professionals with COVID-19 in a General Surgery Department as the incidence increases among the general population of their regional care area&#44; as well as to study the impact of infection on the service&#8217;s healthcare activity and to evaluate the effect of the measures adopted&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Study setting&#46;</span> We prospectively included in this study patients who had been treated by the General Surgery Department at Hospital Universitario La Paz from March 1 to 31 who presented symptoms compatible with COVID-19&#44; as well as cases with symptoms compatible with COVID-19 among attending surgeons and residents of the service during the same period of time&#46; Ours is a SERMAS &#40;Madrid Health Service&#41; public hospital with 1358 beds&#44; and the General and Gastrointestinal Surgery Department has 34 assistant surgeons and 15 residents&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Definition of cases</span>&#46; The presence of at least one of the following symptoms was considered compatible with COVID-19 infection&#58; cough&#44; dyspnea&#44; sore throat&#44; chest pain&#44; anosmia&#44; dysgeusia or the onset of fever&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> For the confirmation of suspicious cases&#44; the RT-PCR technique was used &#40;according to the methodology available in the Hospital&#8217;s microbiology laboratory&#41; performed with a sample obtained with a nasopharyngeal swab&#46; Patients and physicians with a negative RT-PCR who had maintained symptoms compatible with COVID-19 were re-tested by RT-PCR&#46; Radiological signs that we considered compatible with COVID-19 included&#58; the appearance of peripheral ground glass opacities&#44; diffuse alveolar pattern&#44; bilateral patchy shadows&#44; cobblestone pattern and organizing pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Impact of the SARS-CoV-2 Pandemic on Surgical Patients Treated by the General Surgery Department at the Hospital Universitario La Paz</span><p id="par0050" class="elsevierStylePara elsevierViewall">From March 1 to March 31&#44; 2020&#44; 189 patients underwent surgery in the General and Gastrointestinal Surgery Department&#58; 100 were scheduled surgeries with hospitalization&#44; 36 urgent surgeries&#44; and 53 major outpatient surgery at Hospital Carlos III&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">From March 1 to 10&#44; the service maintained its usual healthcare activity&#46; As of March 11&#44; surgical procedures for benign pathologies were suspended&#46; Starting March 16&#44; patients with oncological pathology were selected&#44; prioritizing those with risk of imminent complications&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Out of the 153 patients who underwent scheduled surgery from March 1 to 31&#44; 2020&#44; 7 presented symptoms compatible with COVID-19&#44; and RT-PCR confirmed SARS-CoV-2 infection &#40;4&#46;57&#37;&#41; in the immediate postoperative period&#46; In the group of patients who underwent surgery with hospitalization&#44; the percentage of patients who developed COVID-19 was 7&#37;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">During the postoperative period of the 36 patients who underwent urgent surgery&#44; 2 were SARS-CoV-2&#43;&#44; confirmed by RT-PCR&#44; and one had symptoms highly suggestive of COVID-19 &#40;11&#46;1&#37;&#41;&#46; All 3 patients died of respiratory failure&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The mean age of the SARS-CoV-2-positive patients who underwent scheduled surgery was 59&#46;5 years&#44; and the mean age of patients who underwent urgent surgery was 81 years&#46; In terms of sex&#44; 42&#46;8&#37; of all patients with infection were male&#46; The most frequent comorbidities among these patients were obesity&#44; DM and COPD &#40;present in 3 patients&#41;&#44; followed by HTN and heart failure &#40;2 patients&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We should also mention a 72-year-old patient who underwent urgent surgery for perforation of the small intestine&#44; followed by a slow recovery due to intra-abdominal abscesses and 23 days of hospitalization&#44; who later presented respiratory symptoms 8 days after hospital discharge&#46; Pneumonia due to COVID-19 was confirmed by CT scan and RT-PCR in 2 nasopharyngeal samples&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Impact on Patients in Scheduled Surgery</span><p id="par0080" class="elsevierStylePara elsevierViewall">Out of the 153 patients who underwent scheduled surgery&#44; 7 presented COVID-19 with confirmation by PCR &#40;4&#46;57&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">From March 1 to 31&#44; 13 patients who had undergone scheduled surgery with hospitalization presented respiratory symptoms and fever between postoperative days 2 and 7&#46; All underwent RT-PCR testing and began wearing surgical masks from the moment of clinical suspicion&#46; In 6 cases&#44; SARS-CoV-2 infection was confirmed during hospitalization &#40;in 2 cases&#44; 2 and 3 samples were taken to confirm infection due to high clinical suspicion and first and&#47;or second negative RT-PCR&#41;&#46; The procedures that had been performed were 2 total gastrectomies for gastric adenocarcinoma&#44; 3 Hartmann procedures &#40;one case for diverticulitis with rectovesical fistula&#44; and 2 for rectal invasion&#44; one for bladder tumor and another for cervical cancer&#41; and one wall closure scheduled after intestinal resection for mesenteric ischemia 6 weeks earlier&#46; In addition&#44; an 81-year-old patient who underwent laparoscopic cholecystectomy was admitted 11 days after discharge for COVID-19 pneumonia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The confirmed SARS-CoV-2 patients were transferred or admitted through the hospital protocol to an isolation floor&#44; with clinical follow-up by an Internal Medicine or Pulmonology team&#46; None of these patients required intensive care due to worsening of symptoms&#59; 3 patients were discharged&#44; 4 remain hospitalized in the ward&#44; and no deaths were registered&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">One 42-year-old patient out of the 53 treated in a major ambulatory surgery regimen consulted for fever and digestive symptoms 19 days after open inguinal hernia surgery&#59; the patient was admitted 3 days later for bilateral SARS-CoV-2-positive pneumonia&#46; This contagion was probably community-acquired since it was beyond the maximum 14-day incubation period described for COVID-19&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Impact on Urgent Surgery Patients</span><p id="par0100" class="elsevierStylePara elsevierViewall">During the first 10 days of March 2020&#44; 2 patients underwent urgent surgery who were not suspected for COVID-19 infection&#58; one with incarcerated abdominal wall hernia &#40;87 years&#41;&#44; and one for perforated acute appendicitis with generalized peritonitis &#40;67 years&#41;&#46; In both cases&#44; orotracheal intubation was carried out with general anesthesia and open surgery&#46; Both patients had a positive SARS-CoV-2 result on postoperative days 6 and 8&#44; respectively&#44; after RT-PCR testing&#46; The first patient went to a hospital ward for 48&#8239;h&#44; again needing orotracheal intubation and ICU admission for respiratory failure on postoperative day 3&#44; and exitus on postoperative day 9&#46; The second patient remained in the ICU intubated from surgery until death on day 10 after surgery&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Similarly&#44; an 89-year-old patient underwent urgent surgery for acute perforated appendicitis with suspected SARS-CoV-2 infection&#44; suggested by right-basal pneumonia on preoperative chest radiograph as well as compatible respiratory symptoms &#40;cough and dyspnea&#41;&#44; although preoperative RT-PCR was negative&#46; Open appendectomy was performed using an infraumbilical midline laparotomy under regional anesthesia&#44; and the surgical team donned personal protective equipment &#40;PPE&#41;&#46; This approach was agreed upon with the on-call anesthesiology team in order to reduce the possibility of contagion during orotracheal intubation&#46; The patient died of respiratory failure on the third postoperative day&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Starting on March 24&#44; following the recommendations of the Spanish Association of Surgeons&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> chest CT<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and preoperative RT-PCR were performed on all patients requiring urgent surgery&#46; From March 24 to 31&#44; 6 patients underwent urgent surgery&#44; all of whom were tested with RT-PCR&#44; 5 thoracic CT scan and one chest radiography&#46; All were negative for SARS-CoV-2 infection&#46; During the postoperative period&#44; they had no symptoms until the last day of the review&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Impact of the SARS-CoV-2 Pandemic on the Urgent Care Activity of the General Surgery Department at the Hospital Universitario La Paz</span><p id="par0115" class="elsevierStylePara elsevierViewall">In the period from February 1 to 29&#44; 2020&#44; 104 urgent procedures were performed &#40;3&#46;6 surgeries per day&#41;&#46; Meanwhile&#44; in the period from March 1 to 31&#44; 36 urgent procedures were performed &#40;1&#46;16 operations per day&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Comparing the activity from March 1 to 31&#44; 2020 with the month of March 2019&#44; the activity &#40;measured in number of admissions and surgical interventions&#41; decreased by 52&#46;7&#37; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">From March 1 to March 10&#44; 22 urgent surgical interventions were performed&#46; From March 11 &#40;the day that social isolation measures were activated by the Government of the Community of Madrid&#41; until the 31st&#44; 14 patients were urgently operated on&#58; 4 perforated acute appendicitis with associated peritonitis&#44; 3 phlegmonous appendicitis&#44; one incarcerated incisional hernia&#44; one incarcerated hernia that did not require intestinal resection&#44; 2 acute perforated diverticulitis with peritonitis in which Hartmann operations were performed&#44; one obstructive splenic angle tumor in which a subtotal colectomy with terminal ileostomy was performed&#44; as well as 2 perianal abscesses&#46; In other words&#44; out of the 14 patients who underwent urgent surgery after March 11&#44; 42&#37; presented peritonitis at diagnosis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">During this period of time&#44; interdisciplinary consultations of COVID-19 patients potentially requiring surgery have also been carried out&#46; Six patients were evaluated&#58; 2&#8239;had acute cholecystitis&#44; and one had an appendicular plastron that was treated conservatively with antibiotics&#46; Another patient had an incarcerated inguinal hernia that was reduced in the hospital ward&#46; Conservative treatment was used to treat 2 patients with thrombosis of the mesenteric vein and rectus sheath hematoma&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Thus&#44; in all patients with SARS-CoV-2 infection who were hospitalized with pathologies that potentially required surgery&#44; conservative treatment was successful&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Impact of the SARS-CoV-2 Pandemic on Surgeons of the General Surgery Department</span><p id="par0140" class="elsevierStylePara elsevierViewall">The period of maximum concentration of cases among surgeons of the General Surgery Department&#44; confirmed with positive RT-PCR for SARS-CoV-2&#44; was between March 10 and 15&#44; with the appearance of 11 cases &#40;7 attendings and 4 residents&#41;&#44; and fever was the main symptom &#40;10 out of 11&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46; In addition&#44; that same week PCR was performed for respiratory symptoms on 4 surgeons&#44; whose results were negative&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Starting March 11&#44; precautionary measures were increased &#40;suspension of clinical sessions and in-person multidisciplinary committee meetings&#44; wearing hospital scrubs and footwear&#44; surgical mask throughout the working day&#44; avoiding touching the face&#44; disinfecting common work surfaces and washing hands with hydroalcoholic solution when entering and leaving the hospital and before and after each patient&#44; even when wearing gloves&#41;&#46; From March 15 to March 31&#44; only one new case was reported among the surgeons of the department&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Three male surgeons with BMI&#8239;&#8805;&#8239;30 presented bilateral pneumonia&#44; and 2 required hospital admission&#46; One of the cases required ICU care&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">On March 9 in the Community of Madrid&#44; the first measures were announced against the rapid expansion of the SARS-CoV-2 coronavirus in order to protect the population&#46; All in-person classes were cancelled&#44; from Early Childhood Education to University levels&#44; which became effective on March 11&#46; Medical consultations&#44; diagnostic tests and non-essential elective surgeries were also cancelled&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">On March 11&#44; the WHO declared the COVID-19 infection as a pandemic&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and on this day the Community of Madrid registered 1024 infected cases and 32 deaths&#44; in a population of 6&#46;6&#8239;&#215;&#8239;10<span class="elsevierStyleSup">6</span> inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Also from this day on&#44; all face-to-face meetings were suspended in the General Surgery Department of the Hospital Universitario La Paz&#44; and multidisciplinary committee meetings were held online&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Likewise&#44; previously scheduled surgical procedures for benign pathology were suspended&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> non-oncological consultations of the Department were canceled&#44; and precautionary measures were maximized among the hospital&#8217;s medical and administrative staff&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">During the following 2 weeks&#44; elective surgeries were scheduled for cancer patients&#44; selecting the highest priority cases due to the risk of early complications&#46; The patients selected did not present fever or active respiratory pathology either at admission or in days prior&#44; and they had had no direct contact with confirmed COVID-19 cases&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic has had a significant impact on healthcare systems worldwide&#46; In general surgery services&#44; three relevant aspects have been affected&#44; all of which have had significant repercussions on the system&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Almost complete reduction of scheduled surgical activity&#44; even in oncology patients&#44; selecting only cases with a high risk of obstruction or perforation&#44; and suspension of all other elective surgery for benign pathology&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Significant reduction of the care burden for on-call services and the number of patients coming to the emergency department with surgical pathologies &#40;appendicitis&#44; cholecystitis&#44; diverticulitis&#44; etc&#46;&#41;&#46; Urgent cases present with greater complexity due to more evolved disease or complicated symptoms when patients finally come to the ER&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">The contagion of surgeons&#44; which entails a consequent period of quarantine and home isolation &#40;and even hospital admission in the most acute cases&#41;&#44; results in a reduced workforce available for daily activities&#44; the coverage of on-call duties and support for other units in the hospital&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">In our case series of highly suspected or confirmed COVID-19 patients&#44; 6 underwent scheduled surgery and 3 had urgent surgery&#46; All patients with urgent procedures died from acute respiratory failure&#44; while the patients treated on a scheduled basis had respiratory symptoms of varying severity&#44; but all responded to medical treatment in a conventional hospital ward&#44; without requiring orotracheal intubation&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">We cannot conclude that COVID-19 infection was the differential element between the two groups of patients&#44; since the mean age of each group &#40;81 vs&#46; 59&#46;5 years&#41; and the clinical severity do not enable us to make comparisons&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In the current situation of the SARS-CoV-2 pandemic&#44; the indication for surgery &#40;both for urgent and programmed procedures&#41; must be evaluated individually&#44; and the benefit of surgery should be weighed against existing alternatives &#40;antibiotic therapy&#44; percutaneous drainage&#44; cholecystostomy&#44; stent placement or delayed surgery until the disease is less prevalent&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">In hospitals that serve an area with a high incidence of COVID-19 cases&#44; preoperative screening is recommended for all patients who are to undergo surgery<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;using RT-PCR and&#47;or thoracic CT scan&#41;&#46; This is necessary in order to select the best available treatment for the patient&#44; as well as the best approach in case of surgery &#40;laparoscopy or laparotomy&#41; and for healthcare workers to take the necessary protective measures &#40;personal protective equipment&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8&#44;13&#44;14</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">In any case&#44; the main objective of patient safety is based on two actions&#58; first&#44; to avoid operating on infected patients who may experience worsened respiratory condition due to intubation and surgical aggression&#59; and&#44; second&#44; to avoid intrahospital infection of non-COVID-19 patients during the postoperative period&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This has been suggested by various national and international guidelines as the impact of COVID-19 disease on surgical patients has become known&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Despite the initial measures taken&#44; the incidence of COVID-19 among surgeons of the General Surgery Department was high during the first part of the study period &#40;23&#46;5&#37; of attending surgeons and 26&#46;6&#37; of surgery residents of the Department were positive&#41;&#46; This was parallel to the rapid increase in cases in an area of high incidence &#40;Community of Madrid&#41;&#46; In this first period in which the peak of cases occurred among surgeons&#44; all the key measures for the protection of healthcare personnel were being implemented&#44; and personal contact until then had been the usual&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Transmission probably occurred in the days prior to taking population and hospital measures&#44; as the incubation period for the coronavirus is 2&#8211;14 days&#44; with a peak in the appearance of symptoms between days 4 and 5&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">After the first confirmed cases in our department&#44; we strictly complied with individual protection measures&#44; as well as disinfection of common areas and the cancellation of physician meetings&#46; These measures&#44; together with the home isolation of all surgeons with suspicious symptoms or confirmed infection&#44; reduced the rate of appearance of new cases&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">The infection of healthcare workers is an added concern in the management of this social and health crisis&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> From the Spanish Association of Surgeons &#40;AEC&#41;&#44; action guidelines have been developed for the treatment of patients who have confirmed or highly suspected SARS-CoV-2 infection&#44; defining which measures must be implemented in general surgery departments at this time&#46; These guidelines are based on the existing literature and are subject to revision as the pandemic evolves in our country&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">A top concern of all healthcare workers&#44; which increases in intensity when someone becomes infected&#44; is the contagion of family members with whom they live&#46; This concern is personal&#44; but it is also institutional because the infection of hospital staff reduces the response capacity of the healthcare system and is a means for propagation of the virus&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0250" class="elsevierStylePara elsevierViewall">The SARS-CoV-2 pandemic is having a major impact on healthcare systems worldwide&#44; requiring available resources to be reorganized&#46; In order to cope with the rapid spread of the coronavirus and the severity of the symptoms it causes&#44; general surgery departments have to drastically modify their surgical and healthcare activities&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Since the onset of COVID-19 cases in the Community of Madrid&#44; a high incidence of infections has been registered in our Department &#40;24&#46;4&#37;&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">The rate of cases with COVID-19 infection managed with surgery and hospitalization was 7&#37;&#46; Mortality was concentrated in senior patients with pathologies requiring urgent surgery&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of Interests</span><p id="par0265" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The rapid spread of SARS-CoV-2 infection has led to a radical reorganization of healthcare resources&#46; Surgical Departments need to adapt to this change&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a prospective descriptive observational study of the incidence of COVID-19 in patients and surgeons of a General Surgical Department in a high prevalence area&#44; between the 1&#8239;st and 31&#8239;st of March 2020&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patients&#58; The incidence of SARS-CoV-2 infection in elective surgery patients was 7&#37; &#40;mean age 59&#46;5 years&#41;&#46; All survived&#46; Of 36 patients who underwent emergency surgery&#44; two of them were SARS-CoV-2 positive and one was clinically highly suspicious of COVID-19 &#40;11&#46;1&#37;&#41;&#46; All three patients died of respiratory failure &#40;mean age 81 years&#41;&#46; Surgeons&#58; There were a total of 12 confirmed SARS-CoV-2&#43; cases among the surgical department staff &#40;24&#46;4&#37;&#41; &#40;8 out of 34 consultants and 4 out of 15 residents&#41;&#46; Healthcare activity&#58; The average number of daily emergency surgical interventions declined from 3&#46;6 in February to 1&#46;16 in March&#46; 42&#37; of the patients who underwent emergency surgery had peritonitis upon presentation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The fast pace of COVID-19 pandemia&#44; should alert surgical departments of the need of adopting early measures to ensure the safety of patients and staff&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La r&#225;pida expansi&#243;n de la infecci&#243;n por SARS-CoV-2&#8239;ha supuesto una radical reorganizaci&#243;n de los recursos sanitarios y la exposici&#243;n de profesionales al contagio&#46; Los servicios de Cirug&#237;a General y del Aparato Digestivo tambi&#233;n necesitan adaptarse a este cambio&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio observacional descriptivo prospectivo de los casos de COVID-19 en pacientes y cirujanos de un Servicio de Cirug&#237;a General en un &#225;rea de alta incidencia de infecci&#243;n entre el 1 y el 31 de marzo de 2020&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pacientes&#58; La incidencia de infecci&#243;n por SARS-CoV-2 en los pacientes programados con hospitalizaci&#243;n en el postoperatorio inmediato fue del 7&#37;&#46; Su edad media fue de 59&#44;5 a&#241;os y todos evolucionaron satisfactoriamente en planta&#46; De 36 pacientes intervenidos de urgencia&#44; dos fueron SARS-CoV-2&#43; y uno altamente sospechoso de COVID-19 &#40;11&#44;1&#37;&#41;&#46; Los tres pacientes fallecieron por insuficiencia respiratoria&#44; su edad media era de 81 a&#241;os&#46; Cirujanos&#58; Hubo un total de 12 casos SARS-CoV-2 &#43; confirmados &#40;24&#44;4&#37;&#41; &#40;8 de 34 adjuntos y 4 de 15 residentes&#41;&#46; Actividad asistencial&#58; El n&#250;mero medio de intervenciones quir&#250;rgicas urgentes diarias baj&#243; de 3&#44;6 en febrero a 1&#44;16 en el mes de marzo&#46; El 42&#37; de los pacientes intervenidos a partir de la entrada en vigor de las primeras medidas de aislamiento a nivel regional&#44; presentaban cuadros evolucionados&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El aumento de casos en la poblaci&#243;n general de COVID-19 debe alertar a los Servicios de Cirug&#237;a General de la necesidad de tomar de medidas de forma precoz que garanticen la seguridad de los pacientes y de los cirujanos&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; &#193;lvarez Gallego M&#44; Gort&#225;zar de las Casas S&#44; Pascual Miguel&#225;&#241;ez I&#44; Rubio-P&#233;rez I&#44; Barrag&#225;n Serrano C&#44; &#193;lvarez Pe&#241;a E&#44; et al&#46; Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirug&#237;a General y del Aparato Digestivo en un hospital terciario&#46; Cir Esp&#46; 2020&#59;98&#58;320&#8211;327&#46;</p>"
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            "apendice" => "<p id="par0270" class="elsevierStylePara elsevierViewall">Ayuela Garc&#237;a S&#44; Cantero Cid R&#44; Castell G&#243;mez JT&#44; Corripio S&#225;nchez R&#44; Del Castillo D&#237;ez F&#44; D&#237;az San Andr&#233;s B&#44; Forero A&#44; Gazo Mart&#237;nez JA&#44; Gonz&#225;lez Alcolea N&#44; Gonz&#225;lez G&#243;mez C&#44; Gonz&#225;lez S&#225;nchez JA&#44; Guerrero Vaquero A&#44; Guti&#233;rrez Iscar E&#44; Heras Garceau M&#44; Losa Bo&#241;ar N&#44; Mariju&#225;n Mart&#237;n JL&#44; Mata Juber&#237;as A&#44; Moquillaza Soller L&#44; Nasimi Sabbagh R&#44; P&#233;rez Robledo JP&#44; Pi&#241;ero Redondo S&#44; Prieto Nieto MI&#44; Quadros Borrajo P&#44; Salinas G&#243;mez J&#44; Tone Villanueva F&#44; Valderr&#225;bano Gonz&#225;lez S&#44; York E&#44; Zapata Syro C&#44; Arteaga Asensio P&#44; Asensio G&#243;mez L&#44; Chavarr&#237;as Torija N&#44; Geg&#250;ndez Sim&#243;n A&#44; Georgiades A&#44; Guevara Mart&#237;nez J&#44; Marcano Chavez C&#44; Moratilla Lape&#241;a L&#44; Prieto Le Noire F&#44; Ramos Mart&#237;n P&#44; Saavedra Ambrosy J&#44; Sarmiento Caldas MC&#44; Toribio V&#225;zquez C&#44; Urbieta Jim&#233;nez A&#44; Vicario Bravo M&#44; Villad&#243;niga S&#225;nchez A&#44; Yebes Alonso A&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Collaborative Workgroup"
            "identificador" => "sec0060"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Daily number of calls to the General Surgery pager during the month of March 2020 &#40;measured in number of total calls from the emergency department and hospital wards&#41;&#46;</p>"
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Article information
ISSN: 21735077
Original language: English
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es en pt

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