Volume 31, Issue 1 (3-2024)
RJMS 2024, 31(1): 1-7 |
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Ethics code: IR.TUMS.VCR.REC.1399.462
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Hajebi R, Miratashi Yazdi S A, Eshraghi N, Khalooeifard R. Management of COVID-19 Patients by Related Specialists Vs Surgeons in Sina Hospital during Fifth Wave of COVID-19. RJMS 2024; 31 (1) :1-7
URL: http://rjms.iums.ac.ir/article-1-8510-en.html
URL: http://rjms.iums.ac.ir/article-1-8510-en.html
Assistant Professor, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran , reza_hajebi2@yahoo.com
Abstract: (166 Views)
Background & Aims: On 2nd February 2020, the first protocol for early detection and treatment of COVID-19 was released by the Center for Disease Control and Prevention (CDC) of Iran's Ministry of Health and Medical Education (MOHME); it has been updated continuously, based on WHO recommendations and new clinical evidences (1-3). In Italy, the same as Iran with a high prevalence of COVID-19, multidisciplinary teams consisting of the specialists of infectious diseases, respiratory medicine and internal medicine were created to treat patients properly. Also due to deterioration of the epidemiological situation in the country, and the shortage of physicians, non-related COVID specialists were trained to treat patients (4). According to actionable guidelines, at the time of crisis, non-related hospital wards, such as surgery wards stopped or reduced regular activities, and admitted to COVID-19 patients. The surgical wards were changed to efficiently adapt to COVID-19 pandemic, includes postpone elective surgery, separate surgery room and postoperative recovery area for COVID-19 patients, and also screening for COVID-19 before surgery (5). As the effectiveness of different interventions in hospitalized COVID-19 patients is still unclear, conducting research is crucial to determine the advantages and disadvantages of executive protocols. The aim of this study was to compare the results of management of hospitalized COVID-19 patients by surgery specialists vs COVID team physicians.
Methods: This cross-sectional study was performed during 30th April- 21th May in Iran. In this period, men's surgery ward of Sina hospital allocated to treat COVID-19 patients; a total of 55 patients were admitted and treated by surgery specialists. The whole data, includes age, sex, use of antibiotics, corticosteroids dose (Dexamethasone and/or Prednisolone), administration of Remdesivir, the duration of hospitalization, transfer to intensive care unit (ICU), number of consultations, total cost and mortality rate were retrospectively gathered from Hospital information system (HIS). Also, the patients were followed up and the rate of return to the hospital with complaints of COVID-19 were collected.
In addition, we extracted the same information for 46 male patients, who were hospitalized at the same time in the VIP ward, and treated by internal medicine specialists or specialists of infectious diseases. During this period, patients with indications of hospitalization were randomly divided between the surgery and the VIP ward. VIP ward is one of the surgery ward in Sina hospital, which does not have any special equipment for COVID-19 patients; the only different between the two wards is that patients in the VIP ward were managed by the related specialist (internal medicine specialists or specialists of infectious diseases).
Results: During a three-week period (April 30 to May 21), a total of 101 COVID-19 patients were hospitalized and examined. The clinical characteristics of the patients are summarized in Table 1. The Mean ± SD age of patients in the surgical department (Group 1) was 16.08 ± 59.58, and 15.03 ± 57.22 in the VIP department (Group 2), with no statistically significant difference found (p = 0.763). The length of hospital stay for patients in the surgical department was non-significantly higher compared to patients in the VIP department (p = 0.412). There was no statistically significant difference between the two groups in the prescription of remdesivir (81.8% in Group 1 vs. 71.7% in Group 2). The number of days of dexamethasone and prednisolone use was significantly higher in Group 1. However, the number of patients who had used prednisolone was significantly higher in Group 2 (p = 0.001). Over 50% of patients (63.6% in Group 1 and 62.2% in Group 2) did not receive antibiotics, and the number of antibiotics received per patient did not differ significantly between the two groups (p = 0.729). Additionally, 12.7% of patients in Group 1 were transferred to the ICU compared to 10.9% in Group 2, with no statistically significant difference observed between the two groups (p = 0.774). The average number of consultations needed for patients in Group 1 was higher than in Group 2, but there was no significant difference (p = 0.36). The mortality rate was 16.4% in the surgical department and 10.9% in the VIP department, with no statistically significant difference found (p = 0.426). The total cost was approximately equal in both groups. Furthermore, there was no significant difference in the rate of patients returning to the hospital with COVID-19 complaints between the two groups (p = 0.711).
Conclusion: During the fifth wave of COVID in Iran, the men's surgery ward of Sina hospital only admitted to COVID-19 patients, and they were treated by surgeons. We designed this study to determine the differences of management of COVID-19 patients by surgeons (non-related specialist) vs related specialist.(7). instructions have been released by MOHME in April 2021, to deal with hospitalized COVID-19 patients at the times of crisis. According to the protocols, in the case of pulmonary involvement in COVID-19 patient, and based on the clinician's judgment, anti-inflammatory, anticoagulant, antiviral (Remdesivir) and antibiotic drugs were started for patients (8). Also, based on the inconsistent results of the recent studies about the benefits of Remdesivir, the CDC considered the decision making on Remdesivir administration for hospitalized patients with moderate disease, to be based on the physician's opinion (9). In this study, the results demonstrated that, the use of Remdesivir is not distinct between the two groups. Recent studies, showed that the administration of Dexamethasone for patients, who required supplemental oxygen was associated with a lower mortality rate. In addition, it was recommended that the choice of appropriate dose, at the right time for the right patient is essential for advantageous impact of glucocorticoids in many viral respiratory infections (10-12). Our findings showed, that the selection of corticosteroids and dosage were different among the two group of patients. Like the use of glucocorticoids, due to insufficient information about the beneficial effects of antibiotic therapy in COVID-19 patients, further studies are crucial to determine the indication and duration of antibiotic for patients (13). Although uncertainty about antibiotic therapy, our statistical analysis showed no significant differences between the two groups. Hashmi .et al concluded, that CURB-65 score and baseline clinical factors are not able to determine the ICU admission need for COVID-19 patients, subsequently the necessity of transfer to ICU should be individualized for patients, based on physician’s opinion (14). Although the types of management were different between the two groups, but no difference was seen in the rate of transfer to ICU between the two wards. In addition, the number of required consultations was not different among the surgery and VIP ward's patients. Garrigues et al declared that the most of the COVID-19 patients have continuous symptoms after discharge from the hospital (15). The result of this study demonstrated, that the rate of return to hospital were not different between the two groups. As a result, the treatment plan was slightly different between them, but the patient's outcomes including: the mortality rate, the total cost and the rate of return to the hospital were not different. It seems, that our results are in line with the Iranian guideline's recommendations about management of hospitalized COVID-19 patients at the times of crisis.
However, this study has several limitations that should be considered. Firstly, the sample size of 101 patients may not be representative of larger populations, potentially limiting the generalizability of the findings. Secondly, the retrospective nature of the study might introduce biases and confounding factors that could impact the validity of the results. Additionally, the lack of detailed information on comorbidities and disease severity could hinder a comprehensive understanding of the factors influencing patient outcomes.
Methods: This cross-sectional study was performed during 30th April- 21th May in Iran. In this period, men's surgery ward of Sina hospital allocated to treat COVID-19 patients; a total of 55 patients were admitted and treated by surgery specialists. The whole data, includes age, sex, use of antibiotics, corticosteroids dose (Dexamethasone and/or Prednisolone), administration of Remdesivir, the duration of hospitalization, transfer to intensive care unit (ICU), number of consultations, total cost and mortality rate were retrospectively gathered from Hospital information system (HIS). Also, the patients were followed up and the rate of return to the hospital with complaints of COVID-19 were collected.
In addition, we extracted the same information for 46 male patients, who were hospitalized at the same time in the VIP ward, and treated by internal medicine specialists or specialists of infectious diseases. During this period, patients with indications of hospitalization were randomly divided between the surgery and the VIP ward. VIP ward is one of the surgery ward in Sina hospital, which does not have any special equipment for COVID-19 patients; the only different between the two wards is that patients in the VIP ward were managed by the related specialist (internal medicine specialists or specialists of infectious diseases).
Results: During a three-week period (April 30 to May 21), a total of 101 COVID-19 patients were hospitalized and examined. The clinical characteristics of the patients are summarized in Table 1. The Mean ± SD age of patients in the surgical department (Group 1) was 16.08 ± 59.58, and 15.03 ± 57.22 in the VIP department (Group 2), with no statistically significant difference found (p = 0.763). The length of hospital stay for patients in the surgical department was non-significantly higher compared to patients in the VIP department (p = 0.412). There was no statistically significant difference between the two groups in the prescription of remdesivir (81.8% in Group 1 vs. 71.7% in Group 2). The number of days of dexamethasone and prednisolone use was significantly higher in Group 1. However, the number of patients who had used prednisolone was significantly higher in Group 2 (p = 0.001). Over 50% of patients (63.6% in Group 1 and 62.2% in Group 2) did not receive antibiotics, and the number of antibiotics received per patient did not differ significantly between the two groups (p = 0.729). Additionally, 12.7% of patients in Group 1 were transferred to the ICU compared to 10.9% in Group 2, with no statistically significant difference observed between the two groups (p = 0.774). The average number of consultations needed for patients in Group 1 was higher than in Group 2, but there was no significant difference (p = 0.36). The mortality rate was 16.4% in the surgical department and 10.9% in the VIP department, with no statistically significant difference found (p = 0.426). The total cost was approximately equal in both groups. Furthermore, there was no significant difference in the rate of patients returning to the hospital with COVID-19 complaints between the two groups (p = 0.711).
Conclusion: During the fifth wave of COVID in Iran, the men's surgery ward of Sina hospital only admitted to COVID-19 patients, and they were treated by surgeons. We designed this study to determine the differences of management of COVID-19 patients by surgeons (non-related specialist) vs related specialist.(7). instructions have been released by MOHME in April 2021, to deal with hospitalized COVID-19 patients at the times of crisis. According to the protocols, in the case of pulmonary involvement in COVID-19 patient, and based on the clinician's judgment, anti-inflammatory, anticoagulant, antiviral (Remdesivir) and antibiotic drugs were started for patients (8). Also, based on the inconsistent results of the recent studies about the benefits of Remdesivir, the CDC considered the decision making on Remdesivir administration for hospitalized patients with moderate disease, to be based on the physician's opinion (9). In this study, the results demonstrated that, the use of Remdesivir is not distinct between the two groups. Recent studies, showed that the administration of Dexamethasone for patients, who required supplemental oxygen was associated with a lower mortality rate. In addition, it was recommended that the choice of appropriate dose, at the right time for the right patient is essential for advantageous impact of glucocorticoids in many viral respiratory infections (10-12). Our findings showed, that the selection of corticosteroids and dosage were different among the two group of patients. Like the use of glucocorticoids, due to insufficient information about the beneficial effects of antibiotic therapy in COVID-19 patients, further studies are crucial to determine the indication and duration of antibiotic for patients (13). Although uncertainty about antibiotic therapy, our statistical analysis showed no significant differences between the two groups. Hashmi .et al concluded, that CURB-65 score and baseline clinical factors are not able to determine the ICU admission need for COVID-19 patients, subsequently the necessity of transfer to ICU should be individualized for patients, based on physician’s opinion (14). Although the types of management were different between the two groups, but no difference was seen in the rate of transfer to ICU between the two wards. In addition, the number of required consultations was not different among the surgery and VIP ward's patients. Garrigues et al declared that the most of the COVID-19 patients have continuous symptoms after discharge from the hospital (15). The result of this study demonstrated, that the rate of return to hospital were not different between the two groups. As a result, the treatment plan was slightly different between them, but the patient's outcomes including: the mortality rate, the total cost and the rate of return to the hospital were not different. It seems, that our results are in line with the Iranian guideline's recommendations about management of hospitalized COVID-19 patients at the times of crisis.
However, this study has several limitations that should be considered. Firstly, the sample size of 101 patients may not be representative of larger populations, potentially limiting the generalizability of the findings. Secondly, the retrospective nature of the study might introduce biases and confounding factors that could impact the validity of the results. Additionally, the lack of detailed information on comorbidities and disease severity could hinder a comprehensive understanding of the factors influencing patient outcomes.
Keywords: COVID-19, Treatment Management, Disease-Related Physicians, Non-Disease-Related Physicians, Surgeon
Type of Study: Research |
Subject:
Infectious Disease
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