The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies

Abstract

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP—appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

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

“…Farber et al ( 23 ) reported similar results regarding median hospital LOS in surgically managed patients between the two periods. Finally, Guadalajara et al ( 16 ) found a prolonged LOS in 2020 (6 days) compared to 2019 and 2021 (4 days both). This observation can be explained by the selection of conservative treatment and the fewer laparoscopy rates during the first wave of the pandemic, which can be attributed to concerns about the transmission of the virus with aerosolization.…”

“…The mild complication rate (CDI or CDII) was similarly higher in the pandemic period ( 11 ). Finally, Guadalajara et al ( 16 ) reported increased complication rates of any Clavien-Dindo grade during 2020 compared both to 2019 and 2021. The difference between 2020 and 2021 is statistically significant ( p = 0.026).…”

“…A total of 1,333 patients were studied before and 1,235 after the onset of the pandemic. Four studies reported numbers in all three different approaches regarding acute cholecystitis management and are therefore examined together ( 13 , 15 , 16 , 23 ). Combining the results of these studies, 344 patients were examined before and 497 during the COVID-19 period.…”

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

“…In Ontario, patients with prior COVID-19 infection had a lower risk of multiple common surgeries [ 52 ]. An assessment of 10 hospitals in Spain revealed decreased laparoscopic approaches and longer stays, indicating that the standards had suffered [ 53 ]. Studies have also projected increased costs due to surgical delays [ 29 ].…”

The international PIACO study: pattern of surgical approaches for acute surgical pathologies in SpainversusUK. Was conservative treatment and open surgery during COVID-19 the way to go?

“…During the first wave of the SARS-CoV-2 pandemic, drastic restructuring of surgical services was applied, as part of a larger scheme aiming to protect health systems from being overwhelmed during the pandemic 1 , 2 . As a result of reserving resources to cope with the expected influx of patients with COVID-19, elective activity was postponed and acute surgical cases were treated preferably in an ambulatory rather than an inpatient setting 3–5 .…”