The impact of the COVID-19 pandemic on emergency general surgery: a retrospective study

Abstract

BACKGROUND: The COVID-19 pandemic has affected healthcare systems worldwide. The effect of the pandemic on emergency general surgery patients remains unknown. OBJECTIVE: To reveal the effects of the COVID-19 pandemic on mortality and morbidity among emergency general surgery cases. DESIGN AND SETTING: Data on patients who were admitted to the emergency department of a tertiary hospital in Samsun, Turkey, and had consultations at the general surgery clinic were analyzed retrospectively. METHODS: Our study included comparative analysis on two groups of patients who received emergency general surgery consultations in our hospital: during the COVID-19 pandemic period (Group 2); and on the same dates one year previously (Group 1). RESULTS: There were 195 patients in Group 1 and 132 in Group 2 (P < 0.001). While 113 (58%) of the patients in Group 1 were women, only 58 (44%) were women in Group 2 (P = 0.013). Considering all types of diagnosis, there was no significant difference between the two groups (P = 0.261). The rates of abscess and delayed abdominal emergency diseases were higher in Group 2: one case (0.5%) versus ten cases (8%); P < 0.001. The morbidity rate was higher in Group 2 than in Group 1: three cases (1.5%) versus nine cases (7%); P = 0.016. CONCLUSIONS: The COVID-19 pandemic has decreased the number of unnecessary nonemergency admissions to the emergency department, but has not delayed patients' urgent consultations. The pandemic has led surgeons to deal with more complicated cases and greater numbers of complications.

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

“…While many authors have attempted to pair ICD-9 and ICD-10 diagnoses with AAST severity scores, this mapping remains imperfect. There was no difference in distribution of EGS diagnoses across our time periods, similar to other studies [ 9 ]. We similarly attempted to examine severity based on ICD-diagnosis codes mapped to AAST severity grades and to AAST Complexity levels as described in a previous publication [ 20 ].…”

“…However, the higher percentage of cases lasting over an hour and over 3 hours would suggest that there may have been some increased technical intraoperative challenges. Similar to Tarim, et al, we did not identify a difference in overall LOS [ 9 ]. Our COVID-19 pandemic population had lower 30-day mortality but higher 30-day readmission rates.…”

“…Notably, while all the clinical and laboratory values were statistically significant in that study, it’s unclear if they were clinically different. In a study in Turkey, authors found a higher rate of abscess and delayed abdominal emergency diseases, but no difference in time from beginning of complaints to presentation to the ED [ 9 ]. There remains no objective standardized method to measure severity of disease across a large cohort of patients, therefore, we attempted to examine severity of disease from multiple angles.…”

COVID-19 pandemic and its impact on emergency surgical services: A mini-review

“…Future developments also need to address to handle such crises. This crisis helps LMICs to empower their communities and healthcare system to improve awareness among community and healthcare facilities [17] [19].…”

“…The reported cases include Colon Appendectomy or resection of small bowel, Hartmann surgical resection, Iridectomy, repairing of GIS perforation, Total gastrectomy, Hernia repair or Herniography, and laparotomy. All patients were diagnosed by Nonspecific abdominal pain, acute appendicitis, acute hepatobiliary infections, acute mesenteric ischemia, GIS perforations, Intestinal obstructions, and GIS bleeding [17].…”