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Proctologic Surgery Prioritization After the Lockdown: Development of a Scoring System
Renato Pietroletti1, Gaetano Gallo2, Mario Muselli3
1Surgical Coloproctology Hospital Val Vibrata, Sant'Omero (TE) and Department of Clinical and Biotechnological Sciences University of L'Aquila, L'Aquila, Italy.
Insights
The COVID-19 pandemic disrupted surgical care. A telephone-based severity index effectively prioritized patients for coloproctology surgery after lockdown, aiding efficient rescheduling.
Area of Science:
- Coloproctology
- Surgical Outcomes
- Public Health
Background:
- The COVID-19 pandemic significantly impacted global surgical procedures, with Italy experiencing severe disruptions.
- Elective surgeries and routine visits were suspended to prioritize urgent and oncologic cases during the initial March 2020 outbreak.
Purpose of the Study:
- To assess the feasibility of a telephone-based severity index for prioritizing patients awaiting coloproctology surgery post-lockdown.
- To stratify patients based on disease severity to facilitate efficient rescheduling of surgical activities.
Main Methods:
- An observational study involved 152 patients awaiting proctological surgery during the national lockdown.
- Patients were interviewed via telephone using a clinician-validated questionnaire to assess their condition.
- A severity index was calculated for various proctologic diseases, categorizing patients accordingly.
Main Results:
- Of 137 patients analyzed, 36.2% required priority surgery (PS), 18.1% deferrable surgery (DS), and 45.6% long-term surgery (L-TS).
- A strong correlation (Spearman's rho = 0.97, p < 0.001) existed between perceived health status and priority class.
- Age and sex did not significantly influence patient classification.
Conclusions:
- A simple, telephone-administered severity score can effectively prioritize patients on surgical waiting lists.
- This tool allows for efficient patient management post-lockdown without requiring immediate clinical examination or hospital visits.
- The developed index offers a practical solution for managing surgical backlogs in coloproctology.
Introduction:
The coronavirus disease 2019 (COVID-19) pandemic has shown a very critical impact on surgical procedures all over the world. Italy faced the deepest impact from the beginning of March 2020. Elective operations, screening, and follow-up visits had been suspended giving priority to urgent and oncologic surgery.
Patients:
An observational study was carried out in the Surgical Coloproctology Unit of the Val Vibrata Hospital on 152 patients awaiting a proctological surgical treatment during the national lockdown.
Methods:
In order to monitor the health status of patients and reschedule postlockdown surgical activities, patients were interviewed by telephone submitting a questionnaire based upon the judgment of an expert senior clinician. Following the interview, we calculated a severity index for all the proctologic diseases (hemorrhoidal disease, anal fissure, anal sepsis, slow transit or obstructed defecation, incontinence), classifying the patients according to the score. Mean age of patients was 53 (±16) years, and there were 84 males (55.3%) and 68 females (44.7%). In total, 31% of our patients suffered from anal fissure, 28% suffered from hemorrhoidal disease, 14% suffered from anal sepsis, and the remaining patients suffered from benign anorectal diseases to a lesser extent.
Results:
A total of 137 patients were available and divided into three classes: priority surgery (PS) with 49 patients (36.2%), deferrable surgery (DS) with 25 patients (18.1%), and long-term surgery (L-TS) with 63 patients (45.6%). There was a significant correlation between the perceived health status reported during the interview and the priority class index (Spearman's rho = 0.97, p < 0.001).Differences related to age and sex were not significant (F-test = 0.43, p = 0.653; chi-squared test = 0.693, p = 0.707). 49 patients in class PS needed a prompt surgical treatment, while 24 patients allocated in class DS and 65 patients allocated in class L-TS could wait for a new ride plan for surgery.
Conclusion:
New tools, such as this simple score obtained during the telephone interview, can be useful for prioritization of patients on the waiting list for surgical coloproctology after the lockdown without further clinical examination and hospital access.
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