The impact of the COVID-19 outbreak on emergency surgery: a Greek emergency department experience

Introduction: Surgical databases are useful for examining outcomes and case volume to improve care, while public interest data has the potential to track the supply and demand of medical services in specific communities. However, the relationship between public interest data and case volume from surgical databases, specifically during disruptive instances like the coronavirus pandemic, is unknown. Therefore, the purpose of this study is to determine how public interest data is related to the case volume of coronavirus and other surgical procedures performed during the coronavirus pandemic.Methods: This retrospective study included a review of appendectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) cases from the National Surgery Quality Improvement Project and relative search volume (RSV) of hip replacement, knee replacement, appendicitis, and coronavirus from Google Trends from 2019 to 2020. T-tests were used to compare surgical caseload and RSV data before and after the COVID-19 surge in March 2020, while linear models were used to determine relationships between confirmed procedures and relative search volumes.Results: The RSV for knee replacement (p < 0.001, Cohen's D [d] = -5.01, 95% confidence interval [CI]: -7.64 to -2.34) and hip replacement (p < 0.001, d = -7.22, 95% CI: -10.85 to -3.57) had a large dip during the coronavirus pandemic, while the RSV for appendicitis had a smaller dip (p = 0.003, d = -2.37, 95% CI: -3.93 to -0.74). Linear models showed very strong linear relationships between surgical RSV and surgical volume for TKA (R 2 = 0.931) and THA (R 2 = 0.940).Conclusions: There was a significant reduction in the number of elective surgeries, which correlated to drops in public interest during COVID-19. The strong correlations between RSV, surgical volume, and coronavirus cases indicate that public interest can be used to track and predict surgical case volume. Our findings allow for greater insight into the use of public interest data to gauge surgical demand.

Section: Discussionmentioning

confidence: 99%

The Relationship Between Public Interest and Surgical Demand During the COVID-19 Pandemic

Abella¹,

Abella²,

Yoshida³

2023

“…A notable exception is that of the Greek experience shared by Mulita et al, who found the overall number of emergency operations to be unaffected (perhaps due to differing local experiences of COVID-19 at the time), and additionally observed a significant increase in the number of strangulated or irreducible inguinal and incisional hernias seen, as well as increased hospital stay and operation time for those emergency presentations [ 10 , 11 ]. This indicates the average severity of presentation at this centre was worse during the COVID-19 era, which may, unfortunately, be a trend we experience in the future.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Hernia Surgery: The South-East Scotland Experience

Ewing¹,

McFadyen²,

Hodge³

et al. 2022

The coronavirus disease 2019 (COVID-19) pandemic resulted in a lockdown in South East Scotland on 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown. The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery. MethodsThe Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020 and for the same time period in 2019. Data were collected on age, gender, anatomical location of the hernia, hernia repair technique, and whether elective or emergency operation. Statistical analysis was performed using the chi-squared test in R-Studio, with a p-value of <0.05 accepted as statistically significant. ResultsThe total number of hernia repairs reduced considerably between 2019 and 2020 (570 vs 149). The majority of this can be explained by a decrease in elective operating (488 vs 87), with the percentage of elective repairs reducing significantly from 85.6% to 58.4% (p<0.001). The inguinal hernia subgroup had a 24% rise in emergency operations from 21 to 26 operations, despite a reduction from 270 to 84 total inguinal repairs. There were just two elective hernia repairs carried out in the first three months of the 2020 study period (5.6% of all operations for April-June) compared to 265 (87.7%) for the same period in 2019 (p<0.001). No statistically significant differences were observed in the rates of laparoscopic versus open operating techniques across the two study periods on any analysis. The age and gender of the patients were similar over the two time periods. ConclusionThe COVID-19 pandemic led to a marked reduction in the number of elective hernia repairs (especially incisional hernia surgery), with the effect most pronounced over the first three months of lockdown. Despite an overall reduction in total emergency operative figures, possibly due to more widespread use of nonoperative strategies, there was still an increase in emergency inguinal hernia repairs during the lockdown. Further studies are needed to evaluate if the delays to elective operating will result in a long-term increase in the rates of emergency presentation.

“…According to the results of Mulita et al, patients in the COVID era presented to the hospital with delayed onset of symptoms, in comparison with those admitted before the COVID pandemic, because of their anxiety and fear of being infected with the coronavirus. As a result the hospital stay, as well as the operation duration of patients in the COVID era, was increased [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Alrahawy¹,

Johnson²,

Aker³

et al. 2022

Aim: This study compares the stage at the presentation of patients with colorectal cancer (CRC) before and after introducing COVID-19 restrictions and the mode of presentation.Methods: This is a retrospective cohort study comparing the incidence of CRC, TNM stage and mode of presentation in the pre-COVID and COVID cohorts at a single UK Trust. All patients discussed at the CRC multidisciplinary team (MDT) from March 2017 to March 2021 were included and split into two cohorts; the pre-COVID group from 01/03/2017 to 29/02/2020 and the COVID group from 01/03/2020 to 28/02/2021. Percentages were used for descriptive statistics. Student's t-test was used for the comparison of demographic variables. Chi-squared test was used for the difference analysis for the categorical data, such as TNM and mode of presentation. P value ≤0.05 was significant.Results: In total, 1373 patients were diagnosed with CRC during the period from March 2017 to March 2021. The pre-COVID group (2017-2020) included 1104 CRC patients, compared to 269 patients in the COVID one (2020-2021). The mean age was higher in the pre-COVID group (p = 0.001). There was a statistically significant increase in the proportion of cases presenting with T4 disease (p = 0.023) and metastatic disease (p = 0.032) in the COVID group compared to the pre-COVID group. There was also a significant increase in the rate of emergency presentations (p < 0.0001). Conclusion:We observed a statistically significant increase in rates of locally advanced (T4) and metastatic (distant) CRC in patients presenting after introducing the COVID-19 lockdown. There was also an increase in emergency presentations. There was no observed difference in nodal status. This may reflect disruption to cancer diagnostic services and the reluctance of patients to access medical care during a pandemic, particularly the elderly.