Impact of COVID-19 on common non-elective general surgery diagnoses

Abstract

Background During the COVID-19 pandemic, public health and hospital policies were enacted to decrease virus transmission and increase hospital capacity. Our aim was to understand the association between COVID-19 positivity rates and patient presentation with EGS diagnoses during the COVID pandemic compared to historical controls. Methods In this cohort study, we identified patients ≥ 18 years who presented to an urgent care, freestanding ED, or acute care hospital in a regional health system with selected EGS diagnoses during the pandemic (March 17, 2020 to February 17, 2021) and compared them to a pre-pandemic cohort (March 17, 2019 to February 17, 2020). Outcomes of interest were number of EGS-related visits per month, length of stay (LOS), 30-day mortality and 30-day readmission. Results There were 7908 patients in the pre-pandemic and 6771 in the pandemic cohort. The most common diagnoses in both were diverticulitis (29.6%), small bowel obstruction (28.8%), and appendicitis (20.8%). The lowest relative volume of EGS patients was seen in the first two months of the pandemic period (29% and 40% decrease). A higher percentage of patients were managed at a freestanding ED (9.6% vs. 8.1%) and patients who were admitted were more likely to be managed at a smaller hospital during the pandemic. Rates of surgical intervention were not different. There was no difference in use of ICU, ventilator requirement, or LOS. Higher 30-day readmission and lower 30-day mortality were seen in the pandemic cohort. Conclusions In the setting of the COVID pandemic, there was a decrease in visits with EGS diagnoses. The increase in visits managed at freestanding ED may reflect resources dedicated to supporting outpatient non-operative management and lack of bed availability during COVID surges. There was no evidence of a rebound in EGS case volume or substantial increase in severity of disease after a surge declined.

COVID-Induced Alterations in Surgical Care and Outcomes in Perforated Diverticulitis

“…A related study of emergency general surgery conditions (that did include diverticulitis) found no increase in ICU utilization, ventilator requirement, nor LOS during the pandemic, which is coordinate with our results, however they found overall lower 30-day mortality during the pandemic (OR .7, P < .01). 5 The lower mortality rate may be due to inclusion of less-ill patients as many patients were managed non-operatively.…”

“…A related study of emergency general surgery conditions (that did include diverticulitis) found no increase in ICU utilization, ventilator requirement, nor LOS during the pandemic, which is coordinate with our results, however they found overall lower 30-day mortality during the pandemic (OR .7, P < .01). 5 The lower mortality rate may be due to inclusion of less-ill patients as many patients were managed non-operatively. In addition, we found no change in patient volume during the pandemic, which agrees with Soriano et al, 17 who found no change in the number of complicated diverticulitis presentations during the pandemic.…”

“…[1][2][3][4] For surgical emergencies, operating rooms remained open, but studies thus far have not shown a consistent trend in the rate of emergency surgeries during the pandemic. Reinke et al and Tebala et al noted no change in the number of patients undergoing surgical management for various emergency general surgery conditions, 5,6 while Hossain et al 7 noted a significant increase in emergency operations for diverticulitis.…”

Emergencies do not shut down during a pandemic: COVID pandemic impact on Acute Care Surgery volume and mortality at a level I trauma center

“…Similarly, the EGS population had equivalent mortality rate before and during the pandemic. Previous analysis of our center have shown that during the pandemic overall rates of EGS patients decreased, 41 but operative volume remained similar, indicating likely less presentation of non-operatively managed disease processes and patients. These are similar to findings of Dick et al who saw a 58% decrease in EGS admission but increased operative rate (19–42%), as well as increased presentation severity.…”

Inpatient treatment of acute diverticulitis between 2010 and 2021 – A German nationwide study about long‐term trends and effects of the SARS‐CoV‐2 pandemic

“…Recent studies from other countries showed a decrease in hospital admissions for emergent general and gastrointestinal surgery during the SAR-SCoV-2 pandemic [12][13][14]. In addition, a review reported that the rate of complicated diverticulitis increased in the first year of the pandemic, whereas the overall number of hospitalizations for acute diverticulitis decreased during the same period of time [15][16][17][18].…”