Impact of the COVID‐19 national lockdown on emergency general surgery: Auckland City Hospital's experience

Abstract

Background: The New Zealand Government announced a four-level COVID-19 alert system soon after the first confirmed case in the country. New Zealand moved swiftly to the highest alert level 4, described as lockdown, as the epidemic curve quickly accelerated. Auckland City Hospital saw a temporary change in acute surgical admissions. The aim of this study is to evaluate the impact of the national lockdown on emergency general surgery. Methods: A retrospective analysis was performed of all patients admitted to Auckland City Hospital via the Acute Surgical Unit during lockdown from 26 March to 27 April 2020. A comparison group was collected from the 33 days prior to lockdown, 22 February to 25 March 2020. Results: The number of admissions decreased by 26% (P-value 0.000). A 56.8% decrease in patients presenting with trauma was found (P-value 0.002). After exclusion of trauma patients, no statistical difference in discharge diagnosis was found. There was a 43.6% reduction in operations performed (P-value 0.037). There was a difference found in the management of appendicitis and cholecystitis (P-value 0.003). Median length of stay was decreased from 1.8 to 1.3 days (P-value 0.031). Conclusion: Auckland City Hospital had a decrease in admissions and operations during the COVID-19 lockdown. These findings suggest people with serious pathology were staying at home untreated or being treated in the community. This is a snapshot of our experience in managing emergency general surgical patients in this unusual period.

The effect of national public health interventions for COVID‐19 on emergency general surgery in Northland, New Zealand

“…This study was confined to Northland which had low levels of COVID‐19 throughout the studied period, limiting the wider applicability. Contrary to many hospitals, no change to surgical management of acute general surgical patients was implemented in Northland in response to the possible increased risk of exposure to COVID‐19 from laparoscopic surgery 23 . This study's findings should also be interpreted through the lens of NZ's unique global situation with a comparatively rapid reversal of the epidemic curve following intense public health restrictions.…”

Association between COVID‐19 public health interventions and major trauma presentation in the northern region of New Zealand

“…The data sheds light on the effect varying levels of public health intervention has on major trauma admissions with the largest decrease in the early intervention period. This was likely the time of greatest uncertainty and fear with limited information on NZ pandemic trajectory 6 . The largest differences in secondary outcomes were seen in the period of greatest public health restriction with the lowest number of RTCs and highest number of injuries at home across the study period in level 4 lockdown.…”

“…Since the onset of public health interventions to control the COVID‐19 pandemic there have been many reports outlining the effect of these interventions on general surgical trauma admissions from around the world 1,6–21 . Various methodologies have been employed with commonly short periods of time used and a time period before the interventions used as a comparator.…”

Acute complex appendicitis during the COVID-19 epidemic: A single-institution retrospective analysis based on real-world data

“…It has been reported that due to the impact of the epidemic, patients have reduced their visits to hospitals for fear of increased risks of COVID-19 infection. [ 7 ] The number of visits to the department of emergencysurgery decreased, [ 16 ] as well as the number of patients in other disciplines, including the postponing of urinary surgical procedures, [ 17 ] decreased outpatient hemodialysis, [ 18 ] interruption of organ transplantation, [ 19 ] and so on. The incidence of acute appendicitis has also decreased, which is consistent with our findings.…”