Emergency surgery in COVID-19 outbreak: Has anything changed? Single center experience

Abstract

BACKGROUND The current coronavirus disease 19 (COVID-19) pandemic is changing the organization of health care and has had a direct impact on the management of surgical patients.At the General Surgery Department of Sant’Anna University Hospital in Ferrara, Italy, surgical activities were progressively reduced during the peak of the COVID-19 outbreak in Italy. During this period, only one operating room was available for elective cancer surgeries and another for emergency surgeries. Moreover, the number of beds for surgical patients had to be reduced to provide beds and personnel for the new COVID-19 wards. AIM To compare 2 different period (from March 9 to April 9 2019 and from March 9 to April 9 2020), searching differences in terms of number and type of interventions in emergency surgery of a main University Hospital in Ferrara, a city in Emilia Romagna region, North of Italy. METHODS This retrospective study was carried out at the General Surgery Department of Sant’Anna University Hospital in Ferrara, Italy. We examined the number of emergency surgeries performed and patient outcomes during the peak of the COVID-19 outbreak in Italy and subsequent total lockdown. We then drew a comparison with the number of surgeries performed and their outcomes during the same period in 2019. The study examined all adult patients who underwent emergency surgery from March 9 to April 9, 2019 ( n = 46), and those who underwent surgery during the first month of the lockdown, from March 9 to April 9, 2020 ( n = 27). Analyses were adjusted for age, gender, American Society of Anesthesiologists classification scores and types of surgery. RESULTS A total of 27 patients underwent emergency surgery at Sant’Anna University Hospital in Ferrara during the first month of the lockdown. This represents a 41.3% reduction in the number of patients who were hospitalized and underwent emergency surgery compared to the same period in 2019. The complication rate during the pandemic period was substantially higher than it was during the analogous period in 2019: 15 out of 27 cases from March 9 to April 9, 2020 (55) vs 17 out of 46 cases from March 9 to April 9, 2019 (36.9). Of the 27 patients who underwent emergency surgery during the pandemic, 10 were screened for COVID-19 using both thorax high resolution computerized tomography and a naso-pharyngeal swab, while 9 only underwent thorax high resolution computerized tomography. Only 1 patient tested positive for SARS-CoV-2 and died following surgery. CONCLUSION There was a significant reduction in emergency surgeries at our center during the COVID-19 pandemic, and it is plausible that there were analogous reductions at other centers across Italy.

Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?–A retrospective multicenter study

“…These efforts to minimize unnecessary traffic through the healthcare facility resulted in a significant reduction in emergency department patient encounters [ 12 , 13 ]. Significant increases in delayed care for different medical emergencies, including pediatric surgical emergencies, during the COVID-19 pandemic period has been noted by the medical community and published in several reports [ 8 , 9 , 10 , 11 , 12 , 13 ].…”

“…During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature [ 8 , 9 , 10 , 11 , 12 ]. Pediatric patients do not commonly experience medical conditions with a high risk of mortality but delay in diagnosis can lead to a significant increase in morbidity, prolonged hospitalization, increased financial expense and mortality [ 12 ].…”

Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

“…This group showed a reduction of emergency surgery of 41.3% at the peak of pandemic shutdown (with comparable time periods) in a department of general surgery in the University Hospital of Ferrara, Italy, which is located in the Emilia Romagna-a region which was nearly most affected Table 4 Diagnosis of the trauma cases (fracture, soft tissue injury, brain injury) sorted by defined time periods before and during the COVID-19 shutdown Total numbers and incidence proportions are given for defined time periods in first two columns and RRs show the comparison between the SHUTDOWN and CTRL, relative to trauma case numbers, in the third column. All RRs related to a CI not including 1 are highlighted in bold CTRL control, SHUTDOWN shutdown, RR risk ratio, 95% confidence interval CTRL (35d) with total n (incidence proportion: n/575 in %) SHUTDOWN (35d) with total n (incidence proportion: n/417 in %) SHUTDOWN vs. CTRL RR (95% CI) by the pandemic in Europe [14]. Both studies mentioned above describe a reduction of operation numbers in accordance to severity of local infection numbers and to country specific restrictions.…”

The effect of COVID-19 pandemic on inguinal hernia emergencies

“…During the pandemic period, patients were concerned about the risk of COVID-19 infection, and the rate of admissions to hospital emergency departments decreased (14,15). Therefore, the admission time and the duration of strangulation were expected to increase emergency IHs.…”