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Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Rahouma, Mohamed; Baudo, Massimo; Khairallah, Sherif; Lau, Christopher; Gaudino, Mario; El-Sayed Ahmed, Magdy M; Kumar, Akshay; Lorusso, Roberto; Mick, Stephanie L
Angiosarcoma is a rare type of soft-tissue sarcoma arising from endothelial cells. It is considered 'high-grade' by definition, reflecting its aggressive behavior. We sought to investigate the role of surgery in cardiac angiosarcoma, identify late mortality predictors, and identify interactions with other modalities in its treatment using a national dataset. The 2004-2017 National Cancer Database was reviewed for patients with primary cardiac angiosarcoma. Late mortality predictors were evaluated with Kaplan-Meier curves and Cox regression analysis. Surgery in primary cardiac angiosarcoma was performed in 130 patients (median age 50.5 years; female sex 36.9%). The median follow up was 72.02 months, with a median overall survival (OS) of 14.32 months. In patients treated with surgery in combination with other modalities compared with those treated with surgery alone, median OSs were 17.28 and 2.88 months, respectively (log-rank = 0.018). Older patients (age > 57 years) experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This may be partially explained by the difference in treatment strategies among age groups: those with increasing age, less surgery (p = 0.037), and less chemotherapy (p < 0.001) were chosen. With multivariable Cox regression analysis, age and race other than white or black were identified to be significant independent predictors of late mortality. Cardiac angiosarcoma has poor overall survival, and our findings should further encourage the use of surgery in combination with other therapeutic modalities in treating such an aggressive disease whenever possible.
PMCID:10744152
PMID: 38137833
ISSN: 2077-0383
CID: 5611992

Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Rahouma, Mohamed; Baudo, Massimo; Khairallah, Sherif; Lau, Christopher; Gaudino, Mario; El-Sayed Ahmed, Magdy M.; Kumar, Akshay; Lorusso, Roberto; Mick, Stephanie L.
Angiosarcoma is a rare type of soft-tissue sarcoma arising from endothelial cells. It is considered "˜high-grade"™ by definition, reflecting its aggressive behavior. We sought to investigate the role of surgery in cardiac angiosarcoma, identify late mortality predictors, and identify interactions with other modalities in its treatment using a national dataset. The 2004"“2017 National Cancer Database was reviewed for patients with primary cardiac angiosarcoma. Late mortality predictors were evaluated with Kaplan"“Meier curves and Cox regression analysis. Surgery in primary cardiac angiosarcoma was performed in 130 patients (median age 50.5 years; female sex 36.9%). The median follow up was 72.02 months, with a median overall survival (OS) of 14.32 months. In patients treated with surgery in combination with other modalities compared with those treated with surgery alone, median OSs were 17.28 and 2.88 months, respectively (log-rank = 0.018). Older patients (age > 57 years) experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This may be partially explained by the difference in treatment strategies among age groups: those with increasing age, less surgery (p = 0.037), and less chemotherapy (p < 0.001) were chosen. With multivariable Cox regression analysis, age and race other than white or black were identified to be significant independent predictors of late mortality. Cardiac angiosarcoma has poor overall survival, and our findings should further encourage the use of surgery in combination with other therapeutic modalities in treating such an aggressive disease whenever possible.
SCOPUS:85180651469
ISSN: 2077-0383
CID: 5630622

Lung Transplantation

Chapter by: Kumar, Akshay; Anjum, Fatima
in: StatPearls by
Treasure Island FL : StatPearls, 2023
pp. -
ISBN:
CID: 5443842

Cardiac Surgery

Chapter by: Senst, Benjamin; Kumar, Akshay; Diaz, Rene R.
in: StatPearls by
Treasure Island (FL): StatPearls Publishing; 2023 Jan
pp. -
ISBN:
CID: 5443852

Gender differences in bicuspid aortic valve Sievers types, valvulopathy, aortopathy, and outcome of aortic valve replacement

Li, Yijia; Chen, Xiongwen; Qi, Yue; Qu, Yichen; Kumar, Akshay; Dong, Songbo; Yang, Yan; Zhao, Qiong
BACKGROUND:The gender difference of the bicuspid aortic valve (BAV) is not well understood. OBJECTIVES:We evaluated the impact of gender on the Sievers types, valvulopathy, aortopathy, and outcomes of aortic valve replacement (AVR) of BAV patients in a cohort of Chinese patients. METHODS:Among 992 BAV patients without aortic dissection nor congenital heart disease, 658 underwent AVR. The demography, Sievers types, valvulopathy, aortopathy, and outcomes of AVR were compared between genders. RESULTS:Aortic regurgitation (AR ≥ 2+) (39.0% vs. 12.8%, p < .001), aortic root dilation only (3.8% vs. .8%, p = .014), and diffuse dilation (25.3% vs. 4.3%, p < .001) were more common in men, while moderate to severe aortic stenosis (AS) (21.3% vs. 45.7%, p < .001) and ascending dilation only (46.2% vs. 61.2%, p < .001) were more common in women. Men were more prone to develop preoperative AR ≥ 2+ (OR = 5.15, p < .001), moderate to severe AS + AR ≥ 2 + (OR = 2.95, p = .001), and Diffuse aortic dilation (OR = 3.91, p < .001). Sievers types did not have a significant effect on valvular dysfunction. Gender didn't predict early adverse events after AVR (n = 90) (HR = 1.21, p = .44), but male gender predicted a left ventricular ejection fraction <50% after AVR (OR = 3.07, p = .03). CONCLUSIONS:In this BAV series of Chinese patients, gender didn't differ significantly in Sievers types of BAV but showed significant differences in valvulopathy, aortopathy, and LV function after AVR. In addition, the male patients developed more severe conditions at a younger age.
PMID: 35768937
ISSN: 1540-8175
CID: 5339202

Hyperammonemia in lung transplant patients and its management: a review

Kumar, Akshay; Advani, Shailesh; Asim, Kichloo; Mohamed, Mohamed A; Wani, Farah; Singh, Jagmeet; Albosta, Michael; Shiwalkar, Nimisha; Keshavamurthy, Suresh
Objective/UNASSIGNED:To synthesize the evidence for incidence, pathophysiology, etiology, and protocol-based management of hyperammonemia in lung transplant patients. Background/UNASSIGNED:Elevated ammonia levels are toxic to the brain, and hyperammonemia results in a potentially fatal complication for lung transplant recipients. The hallmark of this condition is ammonia production being way out of proportion to the degree of liver derangement. While there are many hypotheses, the cause remains obscure. Methods/UNASSIGNED:A retrospective review of patients with hyperammonemia following lung transplantation was done to understand the pathophysiology, various treatment modalities, and its impact on patient mortality and morbidity. Studies in the English literature were identified through an electronic database search from PubMed/MEDLINE, Ovid Embase, Google Scholar, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Web of Science, and ClinicalTrials.gov until June 2020. No restriction of dates were used, and the search was up until June 2020. Discussion/UNASSIGNED:Mortality among patients with hyperammonemia following lung transplantation is high. Multi-modal treatment approaches include avoiding nephrotoxic drugs, use of bowel decontamination, nitrogen scavengers, branched-chain amino acids, adjustment of immunosuppression, antibiotics like fluoroquinolones or azithromycin, and renal replacement therapy. However, there remains a scarcity of preoperative screening protocol for patients at risk of hyperammonemia as well evidence-based post-operative management guidelines. Intermittent hemodialysis, compared to continuous venovenous hemodialysis, provides better patient outcomes. Conclusion/UNASSIGNED:Early detection of patients at risk by appropriate screening, along with maintaining a high degree of suspicion for hyperammonemia and multi-modal treatment approach, is the key to successful patient outcomes. Further prospective observational studies would facilitate development of protocol-based treatment of this potentially fatal condition.
PMCID:9226249
PMID: 35756952
ISSN: 0970-9134
CID: 5339192

Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review [Case Report]

Kumar, Akshay; Shiwalkar, Nimisha; Bhate, Sameer; Keshavamurthy, Suresh
Patients with cardiac and thoracic trauma remain one of the most difficult presentations to diagnose and treat in an emergency room setting. Here, we present our series of four cases of cardiac and thoracic trauma with varied presentations, including lung, vascular, and diaphragmatic injuries that were managed successfully. We further review the manifestations of cardiac trauma, including cardiac contusions, cardiac rupture, pericardial injury, and valvular injuries; thoracic trauma, including lung and diaphragmatic injury. The sheer complexity of the anatomical structures within the thorax makes it of the utmost importance to timely and appropriately manage them.
PMCID:9246353
PMID: 35800197
ISSN: 2168-8184
CID: 5443752

Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

Murthi, Mukunthan; Shaka, Hafeez; El-Amir, Zain; Velagapudi, Sujitha; Jamil, Abdul; Wani, Farah; Atluri, Ramtej; Kumar, Akshay; Kichloo, Asim
BACKGROUND:Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). METHODS:In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity-matched cohort of patients to compare mortality. RESULTS:In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78-5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95-3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42-2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08-8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99-3.48, p < 0.001) were also higher for PE patients with hypocalcemia. CONCLUSION/CONCLUSIONS:PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.
PMCID:8665606
PMID: 34895211
ISSN: 1471-2466
CID: 5443792

SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: Concerns, challenges, management and mitigation strategies-a narrative review

Kumar, Rakesh; Yeni, Cut Meurah; Utami, Niken Asri; Masand, Rupali; Asrani, Rajesh Kumar; Patel, Shailesh Kumar; Kumar, Akshay; Yatoo, Mohd Iqbal; Tiwari, Ruchi; Natesan, Senthilkumar; Vora, Kranti Suresh; Nainu, Firzan; Bilal, Muhammad; Dhawan, Manish; Emran, Talha Bin; Ahmad, Tauseef; Harapan, Harapan; Dhama, Kuldeep
The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health problem. The SARS-CoV-2 triggers hyper-activation of inflammatory and immune responses resulting in cytokine storm and increased inflammatory responses on several organs like lungs, kidneys, intestine, and placenta. Although SARS-CoV-2 affects individuals of all age groups and physiological statuses, immune-compromised individuals such as pregnant women are considered as a highly vulnerable group. This review aims to raise the concerns of high risk of infection, morbidity and mortality of COVID-19 in pregnant women and provides critical reviews of pathophysiology and pathobiology of how SARS-CoV-2 infection potentially increases the severity and fatality during pregnancy. This article also provides a discussion of current evidence on vertical transmission of SARS-CoV-2 during pregnancy and breastfeeding. Lastly, guidelines on management, treatment, preventive, and mitigation strategies of SARS-CoV-2 infection during pregnancy and pregnancy-related conditions such as delivery and breastfeeding are discussed.
PMCID:8062420
PMID: 34118736
ISSN: 1876-035x
CID: 5443802

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Ielpo, B; Podda, M; Pellino, G; Pata, F; Caruso, R; Gravante, G; Di Saverio, S; Gallo, Gaetano; Lui, Rashid; Orengia, Adam; Chowdary, Aditya; Kulkarni, Aditya; Kuvvetli, Adnan; Navarro, Adolfo; Pisanu, Adolfo; Smith, Adrian; Ibiricu, Adriana Cavero; Nacion, Aeris Jane D; Alsaleh, Ahmad; Alhazmi, Ahmad; Elmabri, Ahmad; Wani, Ajaz; Rencuzogullari, Ahmet; Lasarte, Aingeru Sarriugarte; Rubio, Ainhoa Valle; Bavikatte, Akshay; Kumar, Akshay; Jamiri, Al-Radjid; Padilla, Alain Michel Alvarado; Cacurri, Alban; de San Ildefonso, Alberto; Porcu, Alberto; Sartori, Alberto; Rocca, Aldo; Yáñez, Alejandro Paz; Becaria, Alejandro; Solís-Peña, Alejandro; Sretenović, Aleksandar; Urbistondo, Alex; Bandin, Alfonso; Najar, Alfonso; De Luca, Alessandro; Boddy, Alex; Charalabopoulos, Alexandros; Tzivanakis, Alexios; Amendola, Alfonso; Ramirez-Gutierrez de Velasco, Alfredo; Yildirim, Ali Cihat; Frontali, Alice; Toure, Alpha Oumar; García-Granero, Alvaro; Martínez Roldan, Amaia; Sanz Larrainzar, Amaia; Ratnayake, Amila Sanjiva; Gonzalez-Ganso, Ana María; Minaya-Bravo, Ana M; Das, Andre; Bondurri, Andrea; Costanzi, Andrea; Lucchi, Andrea; Mazzari, Andrea; Musig, Andrea; Peloso, Andrea; Piano, Andrea; Police, Andrea; Mihailescu, Andrei; Pouy, Andrés; Romano, Angela; Iossa, Angelo; Leonetti, Anna Carmen; Guariniello, Anna; Isaac, Anna; Bovi, Anna Pia Delli; Chessa, Antonella; Tromba, Antonella; Álvarez Martínez, Antonio; Brillantino, Antonio; Caira, Antonio; Castaldi, Antonio; Ferronetti, Antonio; Giuliani, Antonio; Prestera, Antonio; Ramos-De la Medina, Antonio; Tarasconi, Antonio; Tornambè, Antonino; Picciariello, Arcangelo; Ioannidis, Argyrios; Leppäniemi, Ari; Khan, Arshad; Rashid, Arshad; Pérez-Sánchez, Arteaga Luis Eduardo; Mittal, Ashok; Mitul, Ashrarur Rahman; Mehraj, Asif; Laharwal, Asim; Dorismé, Asnel; Marinis, Athanasios; Iqbal, Atif; Moncada, Augusto; Braccio, Bartolomeo; Alkhafaji, Basim; de Andrés Asenjo, Beatriz; Martin-Perez, Beatriz; Pérez, Belinda Sánchez; Creavin, Ben; Calì, Benedetto; Pascotto, Beniamino; Stubbs, Benjamin; Retes, Benjamin Zavala; Jovanovic, Branislav; Goh, Brian Kp; Sensi, Bruno; Biddau, Carlo; Gazia, Carlo; Vallicelli, Carlo; Fagundes, Carlos Alberto; Cerdán Santacruz, Carlos; Chirico, Carlos; Gómez, Carlos Javier; Petrola, Carlos; Sánchez Rodriguez, Carlos; Yánez Benítez, Carlos; Dammaro, Carmelisa; Faro, Carmelo Lo; Reinke, Caroline; Dominguez Paez, Casandra; Oliva, Catalina; Paranjape, Charudutt; Thomas, Charlotte; Chia, Chi Fung; Kong, Chi Kwan; De Lucia, Chiara; Chao, Christian Ovalle; Arcudi, Claudio; Guerci, Claudio; Chia, Clement; Parise, Cristiano; Folliero, Cristina; Varela, Cristopher; Ferguson, Dalya M; Camacho, Daniel; Popowich, Daniel; Souza Lima, Daniel; Rega, Daniela; Delogu, Daniele; Zigiotto, Daniele; Vinci, Danilo; D'Antonio, Dario; Parini, Dario; Merlini, David Alessio; Zimmerman, David DE; Moro-Valdezate, David; Pertile, Davide; Giusti, Deborah Maria; Keller, Deborah S; Tarik, Delko; Kalivaçi, Denis; Mazingi, Dennis; Maldonado-Pintado, Diana Gabriela; Sasia, Diego; Linardoutsos, Dimitrios; Osilli, Dixon; Murrone, Domenico; Russello, Domenico; Rodas, Edgar; Acuña Roa, Edisson Alberto; Ricciardi, Edoardo; Rosso, Edoardo; Saladino, Edoardo; Flores-Villalba, Eduardo; Ruiz Ajs, Eduardo; Smith-Singares, Eduardo; Baili, Efstratia; Kouroumpas, Efstratios; Bourmpouteli, Eirini; Douka, Eleftheria; Martin-Perez, Elena; Guaitoli, Eleonora; Samadov, Elgun; Francone, Elisa; Vaterlini, Elisa; Morales, Emilio; Peña, Emilio; Zhao, Enhao; Del Pozo Andres, Eneko; Benzoni, Enrico; Erdas, Enrico; Pinotti, Enrico; Colás-Ruiz, Enrique; Aytac, Erman; Laterza, Ernesto; Agastra, Ervis; Foianini, Esteban; Moscoso, Esteban; Laviano, Estefania; Marra, Ester; Cardamone, Eugenia; Licardie, Eugenio; Mpaili, Eustratia; Pinna, Eva; Varo, Evaristo; Navarro, Fabian Martín; Marino, Fabio; Medas, Fabio; Romano, Fabio; Maraska, Fatlum; Saliu, Fatmir; Madrid, Fausto; Rosa, Fausto; Mastella, Federica; Gheza, Federico; Luvisetto, Federico; Alconchel, Felipe; Vieira, Felipe Monge; Pareja, Felipe; Agresta, Ferdinando; Luna, Fernanda; Bonilla, Fernando; Cordera, Fernando; Burdió, Fernando; Mendoza-Moreno, Fernando; Muñoz Flores, Fernando; Pardo Aranda, Fernando; Taylor, Fiona; Ramos, Flavia L; Fernandes, Flavio; Tropeano, Francesca Paola; Balestra, Francesco; Bianco, Francesco; Ceci, Francesco; Colombo, Francesco; Di Marzo, Francesco; Ferrara, Francesco; Lancellotti, Francesco; Lazzarin, Francesco; Litta, Francesco; Martini, Francesco; Pizza, Francesco; Roscio, Francesco; Virdis, Francesco; Blanco Antona, Francisco; Cervantes Ramírez, Francisco; Fernandez, Francisco Miguel; Llinares, Francisco Oliver; Quezada, Francisco; Schlottmann, Francisco; Herrera-Almario, Gabriel; Massaferro, Gabriel; Bislenghi, Gabriele; van Ramshorst, Gabrielle; Gallo, Gaetano; Luglio, Gaetano; Bointas, Georgios; Kampouroglou, Georgios; Papadopoulos, Georgios; Arredondo Manrique, Gerardo; Calini, Giacomo; Nastri, Giacomo; Formisano, Giampaolo; Galiffa, Giampaolo; Palini, Gian Marco; Colucci, Gianluca; Pagano, Gianluca; Pellino, Gianluca; Vanni, Gianluca; Pattacini, Gianmaria Casoni; Gravante, Gianpiero; De Paola, Gilda; Lisi, Giorgio; Partida, Giovanna; Bellanova, Giovanni; De Nobili, Giovanni; Necchi, Giovanni Sammy; Sinibaldi, Giovanni; Tebala, Giovanni; Bagaglini, Giulia; Izzo, Giuliano; Argenio, Giulio; Brisinda, Giuseppe; Candilio, Giuseppe; Di Grezia, Giuseppe; Esposito, Giuseppe; Faillace, Giuseppe; Frazzetta, Giuseppe; La Gumina, Giuseppe; Nigri, Giuseppe; Romeo, Giuseppe; Chocarro Amatriaín, Gloria; Ortega, Gloria; Martin-Martin, Gonzalo; Stavrou, Gregor A; Gunadi; Ugon, Gustavo Armand; Machain, Gustavo; Marcucci, Gustavo; Martínez-Mier, Gustavo; Machain, Gustavo Miguel; Nari, Gustavo; Calvo, Haydée; Fathy, Hamada; Hamilto; Ahmed, Hazem; Faraj, Hazem; Nava, Hector; Ordas Macias, Hector; Nikaj, Herald; Solano, Heriberto; Khan, Huma Ahmed; Sánchez Alarcón, Humberto; Ebied, Husam; Giani, Iacopo; Villalabeitia Ateca, Ibabe; Neri, Ignacio; Alberdi San Roman, Igor; Fidoshev, Iliya; Martinez Rodriguez, Iñaki; Negoi, Ionut; Ortega, Irene; Bernescu, Irina; Russo, Iris Shari; Vincente Rodríguez, Irune; Palomares, Irving; Baltazar, Isaac; Jaén Torrejimeno, Isabel; Cornejo Jurado, Isabel María; Reccia, Isabella; Hussain, Ishtiyaq; Brito Toledo, Ismael; Mora-Guzmán, Ismael; Dogaru, Iulia; Romic, Ivan; Balciscueta, Izaskun; Kenington, J Cleo; Sagolsem, Jackison; Jang, Jae Y; Olivier, James; Lammel-Lindemann, Jan; Dziakova, Jana; Roldán Villavicencio, Javier Ismael; Salinas, Javier; Pejanovic, Jelena; Parreira, Jose Gustavo; Jovanovic; Rincón Pérez, Jeny; AsReyes, Jeryl; Medina Luque, Jesus Antonio; Mak, Joanna; Salas Rodriguez, Joanne; Herrera Kok, Johnn Henry; Krook, Jon; Diaz-Elizondo, Jose Antonio; Castell, Jose; García-Flores, José Eduardo; Jover Navalón, José María; Silva Rodrigues, Jose Mauro; Pereira, José; Castell Gómez, José Tomas; Bellido Luque, Juan; Martín Del Olmo, Juan Carlos; Salamea, Juan Carlos; Coronel Olivier, Juan Francisco; Blas Laina, Juan Luis; Ordoñez, Juliana Maria; Gutierrez, Julieta; Abba, Julio; Sofi, Junaid Ahmad; Sherafgan, Kashaf; Sahnan, Kapil; Yanaga, Katsuhiko; Beatson, Kevin; Asim, Laharwal; Alvarez, Laura; Siragusa, Leandro; Farber, Lee; Ong, Lester; Athanasios, Liarakos; García-Bruña, Lorena; De Martino, Luca; Ferrario, Luca; Giordano, Luca; Gordini, Luca; Pio, Luca; Ponchietti, Luca; Moletta, Lucia; Curella, Luciano; Poggi, Luciano; Taglietti, Lucio; Bonavina, Luigi; Conti, Luigi; Goffredi, Luigi; Garcia Ruiz, Luis Angel; Barrionuevo, Luis; Fregoso, Luis Enrique; Cabrera, Luis F; Rodriguez, Luis G; Grande, Luis; Gregorio Osoria, Luis; Kantun Gonzalez, Luis Javier; Sánchez-Guillén, Luis; Tallon-Aguilar, Luis; Tresierra, Luis; Giavarini, Luisa; Hasabelnabi, Mahmoud; Odovic, Maja; Uemura, Mamoru; Khan, Mansoor; Artiles-Armas, Manuel; David, Mara; Di Martino, Marcello; Spampinato, Marcello Giuseppe; Ribeiro, Marcelo A F; Viola, Marcelo; Angrisani, Marco; Calussi, Marco; Cannistrà, Marco; Catarci, Marco; Cereda, Marco; Conte, Marco; Giordano, Marco; Pellicciaro, Marco; Marino, Marco Vito; Vaterlini, Maria E; Jiménez, María F; Lolli, María Giulia; Bellini, Maria Irene; Lemma, Maria; Chiarello, Maria Michela; Nicola, Maria; Arrigo, Mario; Caneda Mejia, Mario; Montes Manrique, Mario; Rodriguez-Lopez, Mario; Serradilla-Martín, Mario; Zambrano Lara, Mario; Martínez, Marisa; Bagnall, Mark; Peter, Mark; Cañón Lara, Marta; Jimenez Gomez, Marta; Paniagua-Garcia-Señorans, Marta; Perez Gonzalez, Marta; Rutegård, Martin; Salö, Martin; Franceschilli, Marzia; Silveri, Massimiliano; Veroux, Massimiliano; Pezzulo, Massimo; Nardi, Matteo; Rottoli, Matteo; Tolonen, Matti; Pedraza Ciro, Mauricio; Zuluagua, Mauricio; Cannavò, Maurizio; Cervellera, Maurizio; Iacobone, Maurizio; Montuori, Mauro; Podda, Mauro; García Domínguez, Melody; Bingol-Kologlu, Meltem; Tahir, Mian; Lim, Michael; Wilson, Michael Sj; Wilson, Michael; Campanelli, Michela; Bisaccia, Michele; De Rosa, Michele; Maruccia, Michele; Paterno, Michele; Pisano, Michele; Torre, Michele; Treviño, Michele; Zuolo, Michele; Hernandez Bartolome, Miguel A; Farina, Miguel; Pera, Miguel; Prieto Calvo, Miguel; Sotelo, Milagros; Thway, Min Myat; Hassan, Mohamed; Hassan, Mohamed Salah Eldin; Azfar, Mohammad; Bouhuwaish, Mohammad; Taha, Mohammad; Zaieem, Mohammad; Korkoman, Mohammed; Guraieb, Montserrat; Shalaby, Mostafa; Raza, Muhammad Asif; Younis, Muhammad Umar; Elhadi, Muhammed; Ali, Mujahid Zulfiqar; Quazi, Nadeem; Dudi-Venkata, Nagendra N; Alselaim, Nahar; Loria, Natasha; Villan Ramírez, Nathalie; Than, Nay Win; Smart, Neil; Trelles, Nelson; Pinto, Nicanor; Allievi, Niccolò; Petrucciani, Niccolo; Antonacci, Nicola; Cillara, Nicola; Gica, Nicolae; Cristiana, Nicolaescu Diana; Nicolás, Nicolás; Falco, Nicolò; Pecorelli, Nicolò; Tamini, Nicolò; Dallas, Nikolaos Andreas; Machairas, Nikolaos; Brito, Noelia; Fieturi, Nura Ahmed; Ortega, Nuria; AvilaMercado, Octavio; Irkorucu, Oktay; Alsherif, Omar; Valles, Orestes; Ioannidis, Orestis; Hernández Palmas, Oscar; Hernandez Palmas, Oscar Isaac; Sanz Guadarrama, Oscar; Bozbiyik, Osman; Omelanczuk, Pablo; Ottolino, Pablo; Rodrigues, Pablo; Ruiz, Pablo; Campenni, Paola; Chiarade, Paola; Prieto Olivares, Paola; Baroffio, Paolo; Baroffio, Paolo; Wintringer, Pascal; Di Fronzo, Pasquale; Talento, Pasquale; Favoriti, Pasqualino; Sendino, Patricia; Marsanic, Patrizia; Mifsut, Patricia; Andrade, Paúl; Ajawin, Pawel; Ferri, Valentina; Massimiliano de Luca, Giuseppe; Ingallinella, Sara; Pueyo, Eva; Palmieri, Francesco; Silva, Jesus; Chin, Ken Min; Syn, Nicholas; Goh, Brian K P; Koh, Ye Xin; Tonini, Valeria; Gonzales-Ganso, Ana; Simó, Vicente; Diago, Maria Victoria; Abadía-Barnó, Pedro; Najar Castañeda, Pedro Alfonso; Sillas Arevalos, Pedro Omar; Palazón Bellver, Pedro; Koh, Peng Soon; Souza, Petry; Major, Piotr; Bali, Rajandeep Singh; Khattar, Rakesh Mohan; Melo, Renato Bessa; Ebrahiminia, Reza; Azar, Ricardo; Murga, Ricardo López; Caruso, Riccardo; Pirolo, Riccardo; Brady, Richard; Davies, Richard Justin; Dholakia, Rishi; Rattan, Rishi; Singhal, Rishi; Lim, Robert; Angelico, Roberta; Isernia, Roberta Maria; Tutino, Roberta; Faccincani, Roberto; Peltrini, Roberto; Carrera-Ceron, Rocío; Tejos, Rodrigo; Kashyap, Rohit; Fajardo, Roosevelt; Lozito, Rosa; Madariaga Pareja, Royer; Garbarino, Sabrina; Di Saverio, Salomone; Morales-Conde, Salvador; Benli, Sami; Mansour, Sami; Flores, Samir; Limon Suarez, Samuel; Lopez Ben, Santiago; Fuentes, Sara; Napetti, Sara; Ortiz de Guzmán, Sara; Awad, Selmy; Weckmann Luján, Sergio A; Gentilli, Sergio; Grimaldi, Sergio; Olivares Pizarro, Sergio; Tayar, Serkan; Nabi, Shakeeb; Chan, Shannon M; Junaid, Sheikh; Rojas, Sidney; Monetti, Silvana; García, Silvia; Salvans, Silvia; Tenconi, Silvia; Shaw, Simon; Santoni, Simone; Parra, Sofia Andrea; Cárdenas, Sofía; Pérez-Bertólez, Sonia; Chiappetta, Sonja; Dessureault, Sophie; Delis, Spiros; Bonapasta, Stefano Amore; Rausei, Stefano; Scaringi, Stefano; Keswani, Sundeep; Ali, Syed Muhammad; Cetinkunar, Süleyman; Fung, Tak Lit Derek; Rawashdeh, Tariq; Nicolás López, Tatiana; De Campos, Tercio; Calderon Duque, Teresa; Perra, Teresa; Liakakos, Theodore; Daskalakis, Theodoros; Liakakos, Theodoros; Barnes, Thomas; Koëter, Tijmen; Zalla, Tiku; González, Tomás E; Elosua, Tomás; Campagnaro, Tommaso; Brown, Tommy; Luoto, Topi; Oumar, Touré Alpha; Giustizieri, Ugo; Grossi, Ugo; Bracale, Umberto; Rivas, Uriel; Sosa, Valentina; Testa, Valentina; Andriola, Valeria; Tonini, Valeria; Balassone, Valerio; Celentano, Valerio; Progno, Valerio; Raju, Varun; Carroni, Vanessa; Cavallaro, Venera; Katta, Venkateswara Rao; De Simone, Veronica; Romaguera, Vicent Primo; García Orozco, Victor Hugo; Luraschi, Victor; Rachkov, Victor; Turrado-L, Victor; Visag-Castillo, Victor; Dowling, Victoria; Graham, Victoria; Papagni, Vincenzo; Vigorita, Vincenzo; Cordeiro Fonseca, Vinicius; Jimenez Carneros, Virginia; Bellato, Vittoria; Gonçalves, Walyson; Powers, William F; Grigg, William; Bechstein, Wolf O; Lim, Yu Bing; Altinel, Yuksel; Golubović, Zoran; Balciscueta, Zutoia
BACKGROUND:Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. METHODS:The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. RESULTS:Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. CONCLUSION:Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.
PMID: 34157090
ISSN: 1365-2168
CID: 5443642