Factors Associated with Surgical Timeliness during the COVID-19 Pandemic in Medellin, Colombia: a Cross-sectional Study
DOI:
https://doi.org/10.51326/ec.9.7736101Keywords:
Antisepsis, Intensive Care Units, Operative Surgical Procedures, Perioperative Nursing, Quality of Health Care, SARS-CoV-2Abstract
Introduction: The COVID-19 pandemic drastically disrupted healthcare systems worldwide, causing significant delays in surgical care and jeopardizing the timeliness and safety of procedures. The objective was to describe the factors associated with surgical opportunity in patients operated in a high complexity institution in Medellin, Colombia, during the COVID-19 pandemic.
Methodology: A descriptive study with a cross-sectional analytical component was carried out, including the medical records of 128 patients by census of the period, who were operated on in the period from 2020 July to December. Patients operated under any anesthetic technique (general or regional) of legal age and who were treated in the IPS of the study were included. Procedures performed under local anesthesia or sedation were excluded. For quantitative variables, the Mann-Whitney U test and kruskal wallis test were used to compare with the dependent variable. For each of the analyses, a significance for hypothesis testing (α) of 5% was used, with 95% confidence.
Results and Discussion: It was found that surgical timeliness times were higher in patients coming from outpatient services (p=0.001). It was also observed that professional nurses performed antisepsis in surgeries with better surgical timeliness and that auxiliary nurses performed antisepsis in surgeries with more days (p=0.001). Patients who did not require ICU postoperatively had higher median surgical timeliness (p=0.891), and elective surgery patients had longer waiting times (p=0.001). The involvement of nursing staff in antisepsis was associated with shorter times, underscoring its importance in process optimization.
Conclusion: The results show that surgical timeliness is influenced by multiple factors, including the patient's origin, surgical specialty, type of procedure and personnel involved in asepsis. Patients from outpatient services and those undergoing procedures such as prosthesis replacement and saphenectomy presented longer waiting times. Further studies are required for a better understanding of the phenomenon.
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References
1. Ramos-De la Medina A, Torres Cisneros JR. La cirugía como problema de salud pública en México y el concepto de cirugía global. Cir Gen. 2020;42(1):57-60. https://dx.doi.org/10.35366/92713
2. Aguirre-Gas HG, Zavala-Villavicencio JA, Hernández Torres F, Fajardo-Dolci G. Calidad de la atención médica y seguridad del paciente quirúrgico. Error médico, mala práctica y responsabilidad profesional. Cir Cir. 2010;78(5);456-62. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=25899 [Consultado 05-11-2024]
3. Barrios AJ, Prieto R, Torregrosa L, Álvarez C, Hernández JD, González LG. Volver a empezar: cirugía electiva durante la pandemia del SARS-CoV2. Recomendaciones desde la Asociación Colombiana de Cirugía. Rev Colomb Cir. 2020;35(2):302-21. https://doi.org/10.30944/20117582.656
4. Yraizoz Fuentes J, Villanova López MM, Ávila España F. Capítulo 48. Tratamiento general de las fracturas y complicaciones. En: Manual del residente de C.O.T. de la SECOT. Madrid: SECOT;2014. pp. 237-41. Disponible en: https://unitia.secot.es/web/manual_residente/CAPITULO%2048.pdf [Consultado 05-11-2024]
5. Segnini FJ, Domínguez-Torres LC, Vega-Peña NV. Cancelación de procedimientos quirúrgicos electivos: una agenda para la investigación en Colombia. Iatreia. 2022;35(2):175-82. https://doi.org/10.17533/udea.iatreia.135
6. Saggaf MM, Anastakis DJ. The Impact of COVID-19 on the Surgical Wait Times for Plastic and Reconstructive Surgery in Ontario. Plast Surg (Oakv). 2023;31(4):338-49. https://doi.org/10.1177/22925503211064381
7. Mendivelso Duarte FO, Rodríguez Bedoya M, Barrios Parra AJ. Recomendaciones para la reapertura de servicios de cirugía electiva durante la pandemia por SARS-CoV-2. Rev Panam Salud Pública. 2020;44. https://doi.org/10.26633/RPSP.2020.114
8. Brahin FA, Resina EJ, Toll E. Cirugia mayor ambulatoria. La oportunidad ante la pandemia. Cir Parag. 2020;45(3):6-13. https://doi.org/10.18004/sopaci.2020.diciembre.6
9. Velesville Velásquez KJ. Evidencias sobre el cuidado enfermero en la seguridad del paciente quirúrgico [Trabajo de Fin de Especialidad]. Lima: Universidad Peruana Cayetano Heredia; 2023. Disponible en: https://repositorio.upch.edu.pe/handle/20.500.12866/13110 [Consultado 24-02-2025]
10. Ornelas Flores MC, Parada Pérez MF, León González M, Lucero Serrano F, Mondragón Salgado CG, Castañeda Martínez L. Práctica quirúrgica durante la pandemia por COVID-19: revisión de literatura. Rev Mex Cir Endoscop. 2020;21(1):41-53. https://dx.doi.org/10.35366/97613
11. Morales-Morales CA, González-Urquijo M, Barahona-Iglesias AJ, Abdo-Francis JM, Sobrino-Cossío SR, Bosques-Padilla FJ. Recomendaciones para procedimientos quirúrgicos durante la pandemia de COVID-19 (SARS-CoV-2). Liderazgo hacia el retorno a lo electivo. Cir Cir. 2020;88(6):794-8. https://doi.org/10.24875/CIRU.20000692
12. Brindle ME, Gawande A. Managing COVID-19 in Surgical Systems. Ann Surg. 2020;272(1):e1-e2. https://doi.org/10.1097/sla.0000000000003923
13. Federation of Surgical Specialty Associations. COVID-19 Documents. Federation of Surgical Specialty Associations. [Fecha desconocida]. Disponible en: https://fssa.org.uk/covid-19_documents.aspx [Consultado 16-11-2024]
14. Moletta L, Pierobon ES, Capovilla G, Costantini M, Salvador R, Merigliano S, et al. International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg. 2020;79:180-8. https://doi.org/10.1016/j.ijsu.2020.05.061
15. Jaworska N, Schalm E, Kersen J, Smith C, Dorman J, Brindle M, et al. The impact of delayed nonurgent surgery during the COVID-19 pandemic on surgeons in Alberta: a qualitative interview study. CMAJ Open. 2023;11(4):E587-E596. https://doi.org/10.9778/cmajo.20220188
16. Agulló Herrera RI. Impacto de la pandemia por SARS-CoV-2 sobre la cirugía programada. Valoración y recomendaciones. Revisión bibliográfica [Trabajo de Fin de Grado]. San Cristóbal de La Laguna: Universidad de La Laguna; 2021. Disponible en: https://riull.ull.es/xmlui/handle/915/27098 [Consultado 16-11-2024]
17. Kohnenkampf R, Rocco C, Ortega B. Optimización de los procesos de gestión en cirugía electiva. Rev Chil Anest. 2021;50:20-9. https://doi.org/10.25237/revchilanestv50-03-05
18. Gaceta Médica. El número de pacientes en listas de espera quirúrgicas sigue en aumento superando los 848.000 en junio de 2024. Gaceta Médica. 16 de octubre de 2024. Disponible en: https://gacetamedica.com/politica/el-numero-de-pacientes-en-listas-de-espera-quirurgicas-sigue-en-aumento-superando-los-848-000-en-junio-de-2024/ [Consultado 24-02-2025]
19. Delgado Rivero D, Herrera Vallejera D, Mesa González M, Delgado Rivero D. Recomendaciones de bioseguridad en quirófano durante la pandemia COVID- 19. Experiencia en el CIMEQ. Invest Medicoquir. 2021;13(3). Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=113647 [Consultado 16-11-2024]
20. García JC, Cárdenas Y, García I, Vallejo S, Arteaga A. Working conditions of intensive care unit nurses and quality of care during the pandemic: a qualitative study. Rev Bras Med Trab. 2025;22(4):e20241277. https://doi.org/10.47626/1679-4435-2024-1277
21. García Uribe JC, Gutiérrez Vargas JA, Acevedo Oquendo KJ, Arteaga Noriega AV, Vélez V, Gómez D. Factors related to postoperative ICU admission in pandemic in a Hospital in Medellín, Colombia. Enferm Cuid. 2024;7. https://doi.org/10.51326/ec.7.2752698
22. Díaz A, Osada J. Tiempo de espera quirúrgica en un hospital de Chiclayo, Perú. Rev Peru Med Exp Salud Pública. 2015;32(1):191-204. https://doi.org/10.17843/rpmesp.2015.321.1604
23. Uimonen M, Kuitunen I, Paloneva J, Launonen AP, Ponkilainen V, Mattila VM. The impact of the COVID-19 pandemic on waiting times for elective surgery patients: A multicenter study. PLoS One. 2021;16(7):e0253875. https://doi.org/10.1371/journal.pone.0253875
24. Mysphera. Listas de espera quirúrgicas en España: Estado y posibles soluciones para abordar la situación. Mysphera. 26 de mayo de 2023. Disponible en: https://www.mysphera.com/es/listas-de-espera-quirurgicas-en-espana-estado-y-posibles-soluciones-para-abordar-la-situacion/ [Consultado 18-05-2024]
25. García Uribe JC, López MJ, Betancur Penagos JC, Figueroa LJ. Morbilidad materna e inequidad en tiempos de COVID-19: perspectivas bioéticas. Rev Colomb Bioét. 2024;19(2):e4823. https://doi.org/10.18270/rcb.4823
26. Luque Gómez P, Mareca Doñate R. Conceptos básicos sobre antisepsia y antisépticos. Med Intensiva. 2019;43(Supl 1):2-6. https://doi.org/10.1016/j.medin.2018.11.003
27. González-Nahuelquin C, Palma-Morales M, Plaza-Acosta S, Ruminot-Gana A, Vial-Vilugrón S, Gálvez-Villalobos H, et al. Estrategias de cuidado a pacientes hospitalizados por COVID-19: una revisión sistematizada. Enferm Univ. 2022;19(2):145-64. https://doi.org/10.22201/eneo.23958421e.2022.2.1257
28. Ruiz López PM, Lorenoz Martínez S, Alcalde Escribano J, Mira Solves JJ. Gestión de la calidad de un servicio de cirugía general. Cir Esp (Ed impr);67(4):372-80. Disponible en: https://www.elsevier.es/es-revista-cirugia-espanola-36-articulo-gestion-calidad-un-servicio-cirugia-10044 [Consultado 16-11-2024]
29. World Health Organization. Protocol for surgical site infection surveillance with a focus on settings with limited resources. Geneva: World Health Organization; 2018. Disponible en: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/ipc/ssi-surveillance-protocol.pdf?sfvrsn=d24a1d1c_3&download=true [Consultado 16-11-2024]
30. Munthali J, Pittalis C, Bijlmakers L, Kachimba J, Cheelo M, Brugha R, et al. Barriers and enablers to utilisation of the WHO surgical safety checklist at the university teaching hospital in Lusaka, Zambia: a qualitative study. BMC Health Serv Res. 2022;22(1):894. https://doi.org/10.1186/s12913-022-08257-y
