Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Ita
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ORIGINAL ARTICLE
Thyroid surgery during coronavirus‑19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy D. Zhang1 · Y. Fu1 · L. Zhou1 · N. Liang1 · T. Wang1 · P. Del Rio2 · S. Rausei3 · L. Boni4 · D. Park5 · J. Jafari6 · S. Kargar6 · H. Y. Kim5 · M. L. Tanda7 · G. Dionigi8 · H. Sun1 Received: 19 July 2020 / Accepted: 23 August 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Objective We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019. Methods The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25–February 25, 2020), phase II (February 26–March 19), phase III (March 20–April 20). Results There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers (P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital. Conclusion The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate). Keywords Thyroid · Surgery · Covid19 · SARS-CoV-2 · Thyroidectomy · Cancer · Morbidity · Surgical practice · Recurrent laryngeal nerve palsy · Italy · China · Iran · South Korea
Introduction The historical moment that we are experiencing because of the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) epidemic has forced a reformulation of the rules for the delivery of health services in surgical departments [1–3]. As the number of cases continued to rise, a rapidly increasing number of hospitals were designated by Governments for the exclusive admission of patients with SARS-CoV-2 (Covid19) to contain cross-infection [4–13]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40618-020-01407-1) contains supplementary material, which is available to authorized users. * H. Sun [email protected]
Politicians recommended the limitation of certain scheduled clinical activities [14–21] (Supplementary File 1). The expected effect of the constraint on surgical planning due to the need to limit hospital access was to preserve only essential
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