Id |
Subject |
Object |
Predicate |
Lexical cue |
T169 |
0-10 |
Sentence |
denotes |
DISCUSSION |
T170 |
11-154 |
Sentence |
denotes |
This survey explored the current practice among thoracic surgeons practicing during the COVID-19 pandemic during the second week of April 2020. |
T171 |
155-264 |
Sentence |
denotes |
The response rate of 23% was especially high, considering that only 1 response per institution was requested. |
T172 |
265-382 |
Sentence |
denotes |
This result may reflect the need among surgeons for more information and guidance about working through the pandemic. |
T173 |
383-503 |
Sentence |
denotes |
Indeed, another recent survey reflected a significant level of concern among health care workers regarding COVID-19 [6]. |
T174 |
504-651 |
Sentence |
denotes |
The ESTS is a European society, but more than one-fifth of the responses came from outside Europe, meaning this survey offers a global perspective. |
T175 |
652-696 |
Sentence |
denotes |
The survey also captured a wide demographic. |
T176 |
697-846 |
Sentence |
denotes |
Although the majority of respondents were from academic institutions, there was a wide range in the numbers of COVID-positive patients being managed. |
T177 |
847-1015 |
Sentence |
denotes |
Overall, almost 90% of hospitals were postponing operations and had less critical care capacity, meaning almost all respondents were impacted in one way or another [7]. |
T178 |
1016-1166 |
Sentence |
denotes |
Screening of thoracic surgical patients was mainly conducted with a nasopharyngeal swab and was complemented by CT scanning in one-third of the cases. |
T179 |
1167-1331 |
Sentence |
denotes |
Single-swab testing might be considered a concern because the false negative rate in symptomatic patients is ∼20% but can rise to 100% in asymptomatic patients [8]. |
T180 |
1332-1383 |
Sentence |
denotes |
There was also a wide variety in levels of testing. |
T181 |
1384-1618 |
Sentence |
denotes |
This result, of course, may reflect national governmental policy and is largely dependent on the test capacity per country/region (ranging from 453 to 32 414 tests per million inhabitants for countries represented in this survey) [9]. |
T182 |
1619-1786 |
Sentence |
denotes |
Surgery for patients whose test results were positive for the virus would almost always be postponed for at least 2 weeks, which is based on viral load modelling [10]. |
T183 |
1787-1914 |
Sentence |
denotes |
Although surgeons continue to see patients in person, there has been a significant shift to other forms of remote consultation. |
T184 |
1915-1973 |
Sentence |
denotes |
This approach is a big decision for most surgeons to make. |
T185 |
1974-2130 |
Sentence |
denotes |
It means that the basics of clinical assessment can be lost—including the ability to assess the patient, to undertake exercise testing and to build rapport. |
T186 |
2131-2260 |
Sentence |
denotes |
However, this situation is not unique to thoracic surgery: a survey among maxillofacial surgeons revealed similar practices [11]. |
T187 |
2261-2366 |
Sentence |
denotes |
The preoperative component of thoracic oncology surgery has demonstrated resilience through the pandemic. |
T188 |
2367-2463 |
Sentence |
denotes |
Most hospitals preoperative assessment processes were not impacted or had to make minor changes. |
T189 |
2464-2602 |
Sentence |
denotes |
Although hospitals treating more patients who had test results positive for SARS-CoV-2 (the virus that causes COVID-19) were more limited. |
T190 |
2603-2791 |
Sentence |
denotes |
In accordance with current European Society for Medical Oncology guidelines, accurate staging continued to have a high priority although there was no mention of functional assessment [12]. |
T191 |
2792-2876 |
Sentence |
denotes |
There was evidence that the multidisciplinary meetings have adapted to the pandemic. |
T192 |
2877-2999 |
Sentence |
denotes |
Although there is no formal consensus on prioritizing surgical patients, a remarkable concordance in practice has emerged. |
T193 |
3000-3084 |
Sentence |
denotes |
Patients with low-grade cancer should be deferred when surgical capacity is lacking. |
T194 |
3085-3184 |
Sentence |
denotes |
Additionally, small localized malignant lesions have been considered for stereotactic radiotherapy. |
T195 |
3185-3345 |
Sentence |
denotes |
This practice is followed because it is perceived to entail a lower risk of severe respiratory complications and reduced utilization of critical care resources. |
T196 |
3346-3427 |
Sentence |
denotes |
Locally advanced N2 disease, with a poor prognosis, is not considered a priority. |
T197 |
3428-3612 |
Sentence |
denotes |
Other treatment options (including neoadjuvant treatment, which would allow deferring surgery until after the crisis, or definitive chemoradiation) could be utilized in these patients. |
T198 |
3613-3695 |
Sentence |
denotes |
Conversely, locally advanced N1 disease was perceived as a high surgical priority. |
T199 |
3696-3955 |
Sentence |
denotes |
In reality, trying to prioritize a list of surgical patients, with constrained resources, can be extremely difficult because most organizations only provide COVID-19 recommendations with general principles categorized as high, medium and low priority [12–14]. |
T200 |
3956-4133 |
Sentence |
denotes |
Given that this system provides little differentiation between lung cancer patients being considered for surgery, daily practice remains difficult despite these recommendations. |
T201 |
4134-4310 |
Sentence |
denotes |
Most surgeons feel that the risk of surgery during the current COVID-19 pandemic is higher, although many are clear that they do not know the exact magnitude of the added risk. |
T202 |
4311-4546 |
Sentence |
denotes |
Indeed, there is currently a lack of information in the literature regarding the perioperative course of patients who have test results positive for COVID-19, but an early report seems to confirm increased risk during this period [15]. |
T203 |
4547-4708 |
Sentence |
denotes |
It may therefore be considered alarming that 15% of participants are telling their patients ‘not to worry’ when they are being asked to give consent for surgery. |
T204 |
4709-4804 |
Sentence |
denotes |
Good surgical practice dictates that patients should be fully informed regarding surgical risk. |
T205 |
4805-4877 |
Sentence |
denotes |
The perioperative surgical period was impacted to a much greater extent. |
T206 |
4878-5083 |
Sentence |
denotes |
This outcome is understandable when two-thirds of respondents were involved in the daily care of COVID-19 positive patients and even more in hospitals treating a large number of COVID-19 positive patients. |
T207 |
5084-5171 |
Sentence |
denotes |
Half of the respondents did not have access to full PPE when caring for these patients. |
T208 |
5172-5320 |
Sentence |
denotes |
These results are in line with the results of a survey of the Royal College of Surgeons where 57% of the responders described shortages of PPE [16]. |
T209 |
5321-5398 |
Sentence |
denotes |
PPE is clearly important for keeping health care professionals safe and well. |
T210 |
5399-5508 |
Sentence |
denotes |
Inadequate PPE was found to be a risk factor for COVID-19 infection among orthopaedic surgeons in Wuhan [17]. |
T211 |
5509-5627 |
Sentence |
denotes |
Given the fact that thoracic surgeons are exposed to aerosol-generating procedures, the risk may be much greater [18]. |
T212 |
5628-5776 |
Sentence |
denotes |
This observation, combined with the paucity of testing, means that health care workers continue to work with a sense of significant personal threat. |
T213 |
5777-5878 |
Sentence |
denotes |
Postoperative care might be considered against the small numbers of patients proceeding with surgery. |
T214 |
5879-6097 |
Sentence |
denotes |
However, a potentially significant finding is that 4 of 5 respondents have not adapted the management of chest drains, despite the fact that some societies recommend the use of a digital or a closed filter system [19]. |
T215 |
6098-6239 |
Sentence |
denotes |
There is a reasonable concern that aerosol production by an air leak could spread the viral load, but evidence on this topic is lacking [20]. |
T216 |
6240-6456 |
Sentence |
denotes |
With clear changes in the surgical journey, it can be appreciated why 54.4% of responders were concerned they were unable to provide the best care for their patients and were worried about their own emotional health. |
T217 |
6457-6588 |
Sentence |
denotes |
Indeed stress-related symptoms are being regularly reported in frontline health care workers during the COVID-19 pandemic [21, 22]. |
T218 |
6590-6601 |
Sentence |
denotes |
Limitations |
T219 |
6602-6635 |
Sentence |
denotes |
This survey has some limitations. |
T220 |
6636-6712 |
Sentence |
denotes |
The questions are related only to the practice of thoracic oncology surgery. |
T221 |
6713-6834 |
Sentence |
denotes |
The effect of the pandemic on other thoracic surgical patients remains relevant and fully warrants further investigation. |
T222 |
6835-6983 |
Sentence |
denotes |
Because responses will also ultimately change as the pandemic progresses [23], we plan to take a second survey at a later date to gain further data. |
T223 |
6984-7165 |
Sentence |
denotes |
The fact that some respondents felt there was no answer that accurately described their specific situation should be considered when interpreting the overall results of this survey. |
T224 |
7166-7274 |
Sentence |
denotes |
Finally, the representativeness of this survey should be carefully considered when interpreting the results. |
T225 |
7275-7398 |
Sentence |
denotes |
The majority of the respondents’ hospitals were treating large numbers of patients with COVID-19 at the time of the survey. |
T226 |
7399-7497 |
Sentence |
denotes |
This situation may not represent the situation present in hospitals less affected by the pandemic. |