Lessons for Emergency Surgery in the Second Wave: One-Month Single-Centre Experience During the First Wave of COVID-19

Abstract

The global COVID-19 pandemic had a deleterious effect upon elective and emergency surgery. Focus of patient care was directed to emergency services. Association of Surgeons of Great Britain and Northern Ireland guidelines advised a trend towards conservative management. Traditional surgical intervention was reserved only for selected cases only. We evaluated our emergency practice over a four-week period during the first peak of COVID-19. Methods A retrospective single-centre analysis was performed of consecutive patients seen by the emergency general and vascular surgery on-call team in a District General Hospital over a four-week period (30 March 2020-26 April 2020). Primary outcome was 30-day COVID-19 mortality. Secondary outcomes were 30-day complications, readmission rate and non-COVID-19-related mortality. Adherence to intercollegiate guidelines was also assessed. Results A total of 184 patients were assessed during the period. The median age was 55 years (interquartile range 34-75), with a male:female ratio of 1:0.7. Thirty-day COVID-19-and non-COVID-19-related mortalities were 3% and 8%, respectively. Thirteen percent of patients developed complications and 9% represented to the emergency department within 30 days. Conservative management was initially employed in 78% of patients. This had success rates in appendicitis and cholecystitis of 72% and 75%, respectively. A CT thorax was included in 89% having a CT abdomen and pelvis. Thirty-eight percent had a COVID-19 polymerase chain reaction (PCR) swab test performed throughout the study period. Fifty-two percent of individuals who underwent emergency surgery had a swab performed prior to operative intervention. Conclusions Conservative management seems to be reasonably effective and may reshape the way we treat a proportion of surgical pathologies in the future. Further long-term data are required in order to evaluate this. A paucity of PCR testing was due to nationwide capacity shortcomings. This must be addressed in future peaks with rapid testing in order to triage patients to the appropriate setting.

COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

“…A total of six studies that presented data during the pandemic period were evaluated taking into account the mean LOS as an outcome of their strategy ( Table 2 ). In one study, results regarding LOS were not clearly stated ( 19 ). McGuinness and Hsee ( 22 ) retrospectively performed a comparison of the mean LOS before and during the lockdown period and found no statistically different results between the two periods.…”

The Effect of the COVID 19 Pandemic on Elective Surgical Services in Jos, North Central, Nigeria

“…The COVID 19 pandemic resulted in an upsurge in hospital admissions and a sudden increase in hospital service utilization. The sudden increased demand on healthcare resources led to a skewed distribution of these services in favour of COVID 19 infections [13]. As a consequence of this redistribution, other health services were impacted [28].…”