Impact of COVID-19 on surgical emergencies: nationwide analysis (original) (raw)
Related papers
2021
BACKGROUND: The aim of this retrospective comparative study was to assess the impact of the COVID-19 related disease on emergency surgery, comparing clinical main outcomes in the period March –May 2019 (Group 1) with the same period in Covid-19 Italian lockdown (March-May 2020, Group 2).METHODS: A comparison (Group 1 versus 2) was performed between the demographic, anamnestic, surgical, clinical and management features.RESULTS: 246 patients were included, 137 in Group 1 and 109 in Group 2 (p=0.03). No significant differences in peri-operative characteristics were registered. A declared delay in access to hospital and SARS-CoV-2 preoperatively infection rates were 15.5% and 5.8% respectively in Group 2. The overall morbidity (OR=2.22, 95%CI=1.08-4.55, p=0.03) and 30-day mortality (OR=1.34, 95%CI=0.33-5.50, =0.68) increased significantly in Group 2. Delayed access cohort demonstrated a close correlation with increased morbidity (OR=3.19, 95%CI=0.89-11.44, p=0.07), blood transfusion (O...
World Journal of Emergency Surgery, 2021
Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in gro...
European Journal of Medical Research
Purpose The burden of the coronavirus disease of 2019 (COVID-19) pandemic on the healthcare sector has been overwhelming, leading to drastic changes in access to healthcare for the public. We aimed to establish the impact of implemented government partial and complete lockdown policies on the volume of surgical patient admissions at a tertiary referral center during the pandemic. Methods A database was retrospectively created from records of patients admitted to the surgical ward through the emergency department. Three 6-week periods were examined: The complete lockdown period (CLP), which included a ban on the use of cars with the exception of health service providers and essential sector workers; A pre-COVID period (PCP) 1 year earlier (no lockdown); and a partial lockdown period (PLP) that involved a comprehensive curfew and implementing social distancing regulations and wear of personal protective equipment (e.g., masks) in public places. Results The number of patients admitted ...
2021
Background: The COVID-19 pandemic caused a rise in healthcare demands and has necessitated a significant restructuring of hospital Emergency Departments.The present study aims to determine the pandemic lockdown's impact on the number of patients seeking assessment in the Surgical Emergency Department (SED) with General Surgery emergencies. Methods: Since the start of the Covid pandemic in Greece (1 March, 2020) and up to 15 December 2020, the charts of all patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A; 1/3/2020 to 30/4/2020 and period D; 16/10/2020 to 15/12/2020) and two interim (period B; 1/5/2020 to 15/6/2020 and period C; 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019...
Pattern of surgical emergencies during COVID-19 lockdown in a tertiary care centre
International Surgery Journal
Background: COVID-19 is a novel pandemic affecting almost all countries of the world. The containment measures in form of lockdown taken to prevent its spread has impacted pattern and volume of surgical emergencies. As emergency admissions form a major bulk of total surgical admissions hence this study was planned to look for the impact of lockdown on the spectrum of surgical emergencies in a tertiary care hospital.Methods: A descriptive register based study was done by collecting data of surgical emergencies in three phases – pre lockdown, lockdown and lockdown with relaxations. Data regarding surgical admissions which includes trauma as well as non-trauma emergencies during various phases was collected and analysed.Results: Total number of surgical emergencies decreased by 55.6% during lockdown when compared with pre-lockdown phase. In lockdown phase with relaxations, total admissions increased by 35.2% over lockdown phase however they was overall decrease by 19.4% than pre-lockdo...
The COVID-19 pandemic of 2020 has greatly impacted healthcare systems and society more generally around the world. The management of patients infected with SARS-CoV-2 has primarily impacted emergency departments, medical teams, and intensive care units. However, the impact on health systems as a whole, including surgical specialties, has been wide ranging. We aimed to establish the impact of the COVID-19 pandemic and associated lockdown on the number and characteristics of general surgical patients reviewed and/or admitted by the surgical team within a district general hospital. We performed a retrospective cohort analysis of patients admitted in the 2week period from start of the lockdown (Monday 23rd March 2020 to 5th April 2020), and the same period 1 year earlier (Monday 25th March 2019 to 7th April 2019). Number of patients reviewed and admitted were compared between the two cohorts. Data including diagnosis, operation/procedural interventions, and length of stay were analyzed. The overall number of patients reviewed and admitted by the surgical team was substantially lower during the period of lockdown (61 vs 126). Of the patients seen during lockdown, a smaller proportion were admitted to hospital after initial surgical review (59% vs 77%, p< 0.05). Interventional/operative procedures were performed in a similar proportion of patients in both cohorts (31%). Our data show that there has been a substantial reduction in the number of patients being referred to and admitted by the general surgical team at our center during the COVID-19 pandemic. Explanations for this include reduced attendance due to risk perception of the patients, the impact of lockdown messages and advice regarding self-isolation, as well as an increased threshold for patient admission during the COVID-19 pandemic. Key learning points include the possible benefits of a reduction in admission to hospital of patients with non-urgent conditions.
Impact of lockdown on emergency general surgery during first 2020 COVID-19 outbreak
European Journal of Trauma and Emergency Surgery, 2021
Purpose To evaluate and analyze the impact of lockdown strategy due to coronavirus disease 2019 (COVID-19) on emergency general surgery (EGS) in the Milan area at the beginning of pandemic outbreak. Methods A survey was distributed to 14 different hospitals of the Milan area to analyze the variation of EGS procedures. Each hospital reported the number of EGS procedures in the same time frame comparing 2019 and 2020. The survey revealed that the number of patients during the COVID-19 pandemic outbreak in 2020 was reduced by 19% when compared with 2019. The decrease was statistically significant only for abdominal wall surgery. Interestingly, in 2020, there was an increase of three procedures: surgical intervention for acute mesenteric ischemia (p = 0.002), drainage of perianal abscesses (p = 0.000285), and cholecystostomy for acute cholecystitis (p = 0.08). Conclusions During the first COVID-19 pandemic wave in the metropolitan area of Milan, the number of patients operated for emergency diseases decreased by around 19%. We believe that this decrease is related either to the fear of the population to ask for emergency department (ED) consultation and to a shift towards a more non-operative management in the surgeons 'decision making' process. The increase of acute mesenteric ischaemia and perianal abscess might be related to the modification of dietary habits and reduction of physical activity related to the lockdown.
Intensive Care Medicine
The mobilization of most available hospital resources to manage coronavirus disease 2019 (COVID-19) may have affected the safety of care for non-COVID-19 surgical patients due to restricted access to intensive or intermediate care units (ICU/IMCUs). We estimated excess surgical mortality potentially attributable to ICU/IMCUs overwhelmed by COVID-19, and any hospital learning effects between two successive pandemic waves. Methods: This nationwide observational study included all patients without COVID-19 who underwent surgery in France from 01/01/2019 to 31/12/2020. We determined pandemic exposure of each operated patient based on the daily proportion of COVID-19 patients among all patients treated within the ICU/IMCU beds of the same hospital during his/her stay. Multilevel models, with an embedded triple-difference analysis, estimated standardized in-hospital mortality and compared mortality between years, pandemic exposure groups, and semesters, distinguishing deaths inside or outside the ICU/IMCUs. Results: Of 1,870,515 non-COVID-19 patients admitted for surgery in 655 hospitals, 2% died. Compared to 2019, standardized mortality increased by 1% (95% CI 0.6-1.4%) and 0.4% (0-1%) during the first and second semesters of 2020, among patients operated in hospitals highly exposed to pandemic. Compared to the low-or-no exposure group, this corresponded to a higher risk of death during the first semester (adjusted ratio of odds-ratios 1.56, 95% CI 1.34-1.81) both inside (1.27, 1.02-1.58) and outside the ICU/IMCU (1.98, 1.57-2.5), with a significant learning effect during the second semester compared to the first (0.76, 0.58-0.99). Conclusion: Significant excess mortality essentially occurred outside of the ICU/IMCU, suggesting that access of surgical patients to critical care was limited.
Irish Journal of Medical Science (1971 -), 2021
Purpose The brutal COVID-19 pandemic has majorly impacted populations and health systems, and surgeons have observed dramatic changes in their daily clinical activities. A survey of French digestive surgeons was conducted to assess these changes. Methods An electronic survey was sent to French digestive and general surgeons in the Societe Francaise de Chirurgie Digestive (SFCD) to assess the surgeons' daily activity during the pandemic and investigate changes in patients' management. The care deviations were classified as delay of management, modification of strategy, or modification of organization, and the impact of these changes on patients was evaluated by the surgeon's estimation of loss of chance. Results A major reduction in surgical elective activity was observed in 50 (75%) of the 67 hospitals that responded. Of these, 48 hospitals (71.6%) reported receiving SARS-CoV-2 patients. A deviation from usual care was observed in 10% of patients admitted for emergency general surgery. Among 140 patients presenting a deviation from usual care, 74 (52.9%) had delayed management, 53 (37.9%) had a modification of strategy, and 64 (45.7%) had a modification of organization. Medical treatment instead of surgical treatment was decided for 37 (26.4%) patients, resulting in a high loss of chance for 6 patients. Delays (p < 0.001) and a switch from surgical to medical treatment (p = 0.002) were independently correlated with overall loss of chance based on multivariate analysis. Conclusion This study highlighted the deviations in general emergency surgery patients and provided implications for the solutions that should be implemented during a new health crisis.
2022
Background In 2020, on March the 9th, the Italian Prime Minister announced the lockdown, which was officially closed on May the 4th. This extraordinary measure was necessary to contain the CoVID-19 pandemic spread in Italy. During this phase, a significant decrease of patient’s access to Emergency Department (ED) was observed. Delayed access to treatment may have led to a delay in the diagnosis of acute conditions also in the surgical field, as already documented in other areas, with consequences on surgical outcome and survival.Aim of this study is to provide a detailed description of abdominal urgent-emergent conditions surgically treated and surgical outcomes during the lockdown in a tertiary referral Italian hospital, compared with historical data.MethodsA retrospective review of urgent-emergent patients surgically treated in our department was conducted in order to compare patients’ characteristics and surgical outcomes during the period March 9th - May 4th 2020 with the same p...