Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients

Abstract

Introduction The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methods Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. Results Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase. Conclusions Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

“…Although overall patient numbers are decreasing, especially patients with bowel diseases including appendicitis and diverticulitis present in the emergency rooms with more severe, prolonged and even perforated diseases [3,8,15,16]. Besides that, Tebala et al showed in their international retrospective cohort audit correlations of hospital admissions with general patient condition and physical health [22]. These changes in patient flow into surgical emergency departments as well as the observation of higher proportion of patients with more severe and prolonged diseases might be an expression of ongoing changes in medical evaluation and decision-making processes and a kind of pandemicdriven fear reactions of patients and referring physicians against SARS-CoV-2 infection [23].…”

Surgical safety in the COVID-19 era: present and future considerations

“…Throughout the course of the pandemic, many medical centers simultaneously reported a decrease in their numbers of surgeries, whether they were elective or emergent, or for cancerous or benign resections. The initial prediction made by the COVIDSurg Collaborative group was an 80% decrease in benign and a 30% decrease in malignant cancer surgeries ( Table 1 ) [ 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ]. A multicenter-based report from England and Wales reported a 33.6% decrease in all types of surgeries in 2020 compared to non-pandemic periods (4,671,338 to 3,102,674) [ 7 ].…”

“…Similarly, elective surgery cases in the United States (US) showed a dramatic decrease (34.1% to 81.7%) in several reports, including 2 multicenter studies in the period from March to May 2020 compared to the same months in 2019 [ 9 10 11 12 ]. In addition to elective surgeries, emergent operations have also been reported to decrease by around 30% worldwide [ 13 14 15 ]. Cancer surgeries and obstetric operations have been less affected with centers reporting only a 7.8% reduction in colorectal cancer resections [ 8 ] and a 6% drop in cesarean deliveries [ 11 ].…”

The patterns and changes of general surgical presentations during the first wave COVID-19 pandemic at a metropolitan Sydney hospital

“…18,19 A multicentre European study had similar experiences with a shift in elderly and more frail patients and reduction in appendicitis and diverticulitis, but increase in bowel ischaemia and perianal ailments. 20 Acting within resource limitations and preparation for the wave, the LoS was significantly shorter for appendicitis and cholecystitis in the COVID-19 cohort (2.9 vs. 2.5, p=0.027). The Auckland experience similarly reported fewer operations, albeit non-significant, with a total median LoS difference of 0.5 days between the groups (1.8 vs. 1.3, p=0.031).…”