TY  - JOUR
A1  - Flemming, S.
A1  - Hankir, M.
A1  - Ernestus, R.-I.
A1  - Seyfried, F.
A1  - Germer, C.-T.
A1  - Meybohm, P.
A1  - Wurmb, T.
A1  - Vogel, U.
A1  - Wiegering, A.
T1  - Surgery in times of COVID-19 — recommendations for hospital and patient management
JF  - Langenbeck's Archives of Surgery
N2  - Background
The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeonshave had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards.

Purpose
To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safelyaccommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergencysurgery and oncological patients or jeopardizing the well-being of hospital staff.

Conclusions
The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life whilemaintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards andoperating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidentlyand successfully undertake their respective clinical duties.
KW  - SARS-CoV-2
KW  - COVID-19
KW  - Surgery
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231766
SN  - 1435-2443
VL  - 405
ER  - 
TY  - JOUR
A1  - Diers, J.
A1  - Wagner, J.
A1  - Baum, P.
A1  - Lichthardt, S.
A1  - Kastner, C.
A1  - Matthes, N.
A1  - Matthes, H.
A1  - Germer, C.‐T.
A1  - Löb, S.
A1  - Wiegering, A.
T1  - Nationwide in‐hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany
JF  - BJS Open
N2  - Background
The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue.

Methods
All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined.

Results
Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010).

Conclusion
Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.
KW  - rectal resection
KW  - rectal cancer
KW  - mortality rate
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212878
VL  - 4
IS  - 2
SP  - 310
EP  - 319
ER  -