A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect?

Abstract

Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and their outcomes. Methods Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (16 th February 2020 to 15 th March 2020), and after UK government advice (16 th March 2020 to 15 th April 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p<0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p=0.001), all cause 30-day mortality (8.5% vs. 2.9%, p=0.028), but no significant difference was observed in operative 30-day mortality. Conclusion There appears to be a “lockdown” effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic.

The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study

“…Alboraie et al performed an international survey to investigate the global impact of COVID-19 on gastrointestinal endoscopy units, and they reported that the number of gastrointestinal endoscopic procedures performed during the COVID-19 pandemic was significantly decreased [ 11 ]. Studies from several countries have reported a reduction in surgical admissions during the COVID-19 pandemic [ [12] , [13] , [14] , [15] , [16] , [17] ]. Nunoo-Mensah et al conducted a survey concerning the global effects of COVID-19 on colorectal practice and surgery, and they reported that COVID-19 has affected the ability of colorectal surgeons to offer care to their patients.…”

“…Moreover, after the state of emergency was declared, the number of CRC patients detected by the screening dropped to zero and the number of symptomatic CRC patients increased significantly. McLean et al conducted a single-center observational cohort study in United Kingdom and reported that the incidence of gastrointestinal obstruction was significantly increased after the lockdown imposed by the UK government, although they did not clarify the reasons for the bowel obstructions [ 12 ].…”

COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

“…Currently, research into the impact of the COVID-19 pandemic on emergency general surgery (EGS) has shown an overall decline in operation rates but differing experiences in terms of subsequent case severity. 10 , 11 , 12 , 13 Prior to COVID-19, acute calculus cholecystitis (AC) was one of the most common reasons for EGS admission, with approximately 700,000 reported cholecystectomies performed annually in the United States. 14 , 15 In 2018, gallbladder-related diagnoses comprised 35% of the total EGS volume at our institution.…”

Impact of Covid-19 Disease and National Lockdown on Outcomes of Emergency Surgery. Results From A Retrospective Comparative Cohort Study In A Tertiary Referral Teaching Hospital

“…Nevertheless, bowel obstruction, acute appendicitis, extra-uterine pregnancy and pelvic in ammatory disease (PID) increased. Other authors have also found a change in clinical presentation of emergency cases during the COVID-19 pandemic with a reduction in less severe conditions like urinary tract pathology and an increase in some surgical conditions such as bowel obstruction, acute appendicitis, extra-uterine pregnancy and PID (14). These observations most likely have a multifactorial explanation.…”

“…Subjects with older age, frailty, sepsis, delayed hospital access, comorbities and those who were admitted during lockdown were at higher risk of complications. According to Mc Lean et al(14) patients in need of emergency surgery should attend promptly and receive the surgical care that they require immediately. The risk of perioperative complications associated with COVID 19 disease is signi cant and can affect morbidity and mortality(30).…”