Changes in Emergency General Surgery During Covid‐19 in Scotland: A Prospective Cohort Study

Abstract

Introduction Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. Methods A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. Results A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = \ 0.05) as did severity (0 per cent [ grade 1 vs 58.3 per cent [ grade 1, p = \ 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = \ 0.05) as did the mean operating time (102.4 vs 145.7 min, p = \ 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. Conclusion Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.

Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany

“…When it comes to reducing collateral damage and prognostic disadvantages caused by the pandemic, a key role is played by dedicated patient education and by ensuring the least possible changes to emergency surgical care [ 30 ]. It is undoubtedly essential to emphasize that, in the changed clinical care situation as a result of the pandemic measures, it is crucial to identify patients requiring an emergency operation without delay despite changed circumstances [ 5 ].…”

“…However, the usually low rate of very complicated cases of appendicitis does not allow an uncritical extrapolation of the current results to other surgical emergencies. A comparison with the international literature shows some parallels regarding a reduction in appendectomies [ 13 , 14 ], a later presentation, and an increased inflammatory reaction [ 5 , 15 – 18 , 20 , 31 ]. The international survey of Ielpo et al of more than 700 surgeons worldwide reported a decrease of appendicitis and an increase of complicated cases based on a questionnaire [ 20 ].…”

“…The corona virus disease 2019 (COVID-19) pandemic has led to substantial changes in medical care worldwide [ 1 – 4 ]. International reports have shown an effect on emergency surgery [ 5 , 6 ]. Recently, Slagman et al reported a reduction in medical emergencies by 13% when contact restrictions were in place [ 7 ].…”

“…Regardless of the pandemic, surgeons have to deal with surgical emergencies requiring time-critical surgical measures and emergency surgery in order to avoid substantial prognostic disadvantages [ 5 , 8 ]. Appendicitis represents the most common emergency diagnosis in abdominal surgery and can be used to examine the effects of the COVID-19 pandemic on general emergency surgery [ 9 – 12 ].…”

“…Appendicitis represents the most common emergency diagnosis in abdominal surgery and can be used to examine the effects of the COVID-19 pandemic on general emergency surgery [ 9 – 12 ]. Initial reports, editorials, and smaller, mostly single-center studies have shown a decreasing number of clinically treated appendicitis cases [ 4 , 13 , 14 ] and an increase in disease severity [ 5 , 15 – 18 ]. There has been no sufficient explanation for this phenomenon, since the incidence and severity of acute appendicitis do not appear to be related to the current pandemic or to the imposition of social restrictions.…”