A retrospective of surgical pathology, care problems specific to oncological and non-oncological cases, in a year of the COVID-19 pandemic

Abstract

Introduction. The activity carried out in a general surgery department is complex, the diversity of cases and comorbidities such as cardiovascular diseases, neuro-mental disorders, metabolic diseases, obesity, diabetes influence the care needs of patients. These pathologies increase risks and safety issues in the context of the COVID-19 pandemic. Material and method. We conducted a descriptive retrospective study in which we included 749 patients, of which 184 patients with oncological diseases and 565 with non-oncological diseases, hospitalized at the level of Surgery II, Oradea County Emergency Clinical Hospital, between 15.03.2020 and 15.03.2021. We analyzed the cases of the department in terms of demographic data, oncological and non-oncological cases, comorbidities, types of interventions performed, type of hospitalization, length of hospitalization, mortality, care problems, using FOCG records, care plan and its annexes. Results. 610 surgeries were performed in 749 patients, with an operability rate of 81%. 151 surgeries were performed in the first 24 hours after hospitalization, with or without the result of the RT-PCR test for SARSCoV-2, representing 28% of cases, with additional protection measures and overloading of staff. Of the 184 patients with oncological diseases, 64 were hospitalized by appointment, breast cancer predominates and 120 cases by the emergency department, colorectal cancer predominates. The most common complications in non-oncological surgical cases were: acute cholecystitis with pancreatic reaction, angiocolitis, mechanical jaundice, perforated gallbladder with subhepatic abscess, gastric ulcer perforated with peritonitis, strangulated eventration with loop necrosis, check perforation, occlusions intestinal with severe hydroelectrolytic and metabolic imbalances, septic conditions. Patients with oncological effects presented complications such as: perforated colon cancer with fecal peritonitis, rectal cancer with anal stenosis and rectoria, gastric cancer with upper digestive hemorrhage, pancreatic cancer with mechanical jaundice, intestinal occlusion, esophageal cancer with complete stenosis, cachexia, severe nutritional and metabolic imbalances. Regarding comorbidities, the most common secondary diagnoses associated with the underlying disease were: cardiovascular disease, diabetes, endocrine disorders, neurological and/or psychiatric disorders, obesity, lung disorders. Conclusions. The COVID-19 pandemic made surgical care more difficult due to the rules imposed, the number of hospitalizations decreased, patients delayed the operative moment, with a great impact on the subsequent evolution of the quality of life and survival. In addition to the specific problems of surgical emergencies and oncological cases, a problem for staff was the provision of preoperative and postoperative surgical care to patients with comorbidities such as neuro-mental disorders, metabolic diseases, obesity, diabetes, pathologies that increased risks and safety issues. In the context of the COVID-19 pandemic, the increase in the need for care led to the increase in the consumption of human and material medical resources.

Keywords

• surgical pathology
• comorbidities
• care problems
• covid-19 pandemic