Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

Tebala, Giovanni Domenico; Milani, Marika Sharmayne; Bignell, Mark; Bond-Smith, Giles; Lewis, Chris; Cirocchi, Roberto; Saverio, Salomone Di; Catena, Fausto; Scatizzi, Marco; Marini, Pierluigi

doi:10.21203/rs.3.rs-1106929/v1

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…However, a significant difference has been found for both weekdays and weekends in the rate of frail versus non-frail patients admitted into the participating surgical units during the COVID first wave versus non-COVID period, with more frail patients admitted during the COVID period (2020). This finding has already been highlighted and discussed in another paper [2]. Interestingly, the modalities of treatment changed significantly during the weekend, probably due to local availability or reduced adherence to guidance and protocols.…”

Section: Discussionmentioning

confidence: 54%

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The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case–control analysis of a retrospective multicentre database

Tebala

Milani²,

Cirocchi

et al. 2022

World J Emerg Surg

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Introduction The concept of “weekend effect”, that is, substandard healthcare during weekends, has never been fully demonstrated, and the different outcomes of emergency surgical patients admitted during weekends may be due to different conditions at admission and/or different therapeutic approaches. Aim of this international audit was to identify any change of pattern of emergency surgical admissions and treatments during weekends. Furthermore, we aimed at investigating the impact of the COVID-19 pandemic on the alleged “weekend effect”. Methods The database of the CovidICE-International Study was interrogated, and 6263 patients were selected for analysis. Non-trauma, 18+ yo patients admitted to 45 emergency surgery units in Europe in the months of March–April 2019 and March–April 2020 were included. Demographic and clinical data were anonymised by the referring centre and centrally collected and analysed with a statistical package. This study was endorsed by the Association of Italian Hospital Surgeons (ACOI) and the World Society of Emergency Surgery (WSES). Results Three-quarters of patients have been admitted during workdays and only 25.7% during weekends. There was no difference in the distribution of gender, age, ASA class and diagnosis during weekends with respect to workdays. The first wave of the COVID pandemic caused a one-third reduction of emergency surgical admission both during workdays and weekends but did not change the relation between workdays and weekends. The treatment was more often surgical for patients admitted during weekends, with no difference between 2019 and 2020, and procedures were more often performed by open surgery. However, patients admitted during weekends had a threefold increased risk of laparoscopy-to-laparotomy conversion (1% vs. 3.4%). Hospital stay was longer in patients admitted during weekends, but those patients had a lower risk of readmission. There was no difference of the rate of rescue surgery between weekends and workdays. Subgroup analysis revealed that interventional procedures for hot gallbladder were less frequently performed on patients admitted during weekends. Conclusions Our analysis revealed that demographic and clinical profiles of patients admitted during weekends do not differ significantly from workdays, but the therapeutic strategy may be different probably due to lack of availability of services and skillsets during weekends. The first wave of the COVID-19 pandemic did not impact on this difference.

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Section: Discussionmentioning

confidence: 54%

“…Data for this study were derived from the CovidICE-International Study database, whose characteristics have been reported elsewhere [2].…”

Section: Methodsmentioning

confidence: 99%

The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case–control analysis of a retrospective multicentre database

Tebala

Milani²,

Cirocchi

et al. 2022

World J Emerg Surg

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Surgical Care under COVID-19 Pandemic Conditions (Literature Review)

Тимербулатов

Bakirov

et al. 2022

Kreativnaâ hirurgiâ i onkologiâ

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Since March 2020, when COVID-19 pandemic was declared by WHO, the new coronavirus infection has spread widely around the world, claiming many lives and destroying the economies, social structures, and various aspects of people’s lives. The pandemic has had a major impact on health facilities, including the surgical service. The healthcare system had to completely reorganize its methods of work. The need to deploy a significant number of infectious disease beds necessitated the convertion of many medical organizations into Covid hospitals, with a reduction in surgical units and beds. The scheduled surgical operations were therefore cancelled and postponed. Emergency surgical care was provided as needed, albeit in a reduced scope. The number of patients seeking emergency surgical care decreased mainly due to the fear of contracting COVID-19. The data show that there is a significant increase in the number of perioperative complications and mortality, especially in patients with acute surgical pathology and co-occurring COVID-19. The paper presents the data from professional literature on the peculiarities of surgical care in the context of the coronavirus pandemic, changes in a number of obligatory indicators of the quality of surgical care for patients.

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Surgical and non-operative treatment of acute complicated diverticulitis in a COVID hospital

Tyagunov,

Shcherbakov,

Akhmedov

et al. 2024

Koloproktologiâ

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Surgical treatment of acute abdomen during the SARS-CoV-2 pandemic was accompanied by an extremely high mortality rate, however, only a few studies have presented the results of acute inflammatory complications of diverticular disease (AICDD).AIM: analysis of treatment of AICDD in a COVID-19 hospital.PATIENTS AND METHODS: the retrospective study included 78 patients with acute diverticulitis (AD) from a COVID hospital, confirmed by CT or intraoperative revision. Assessment of COVID pneumonia, comorbidities, organ dysfunction, CT findings, peritonitis, treatment methods, and in-hospital mortality among patients was performed.RESULTS: organ dysfunction of ≥ 1 point on the qSOFA scale was detected in 59.0% of the patients. According to CT data, abdominal distant gas was detected in 48 (61.5%) patients, and pericolic gas in 14 (17.9%) patients. Segmental colon resection was performed in 60 (76.9%) patients, laparoscopic lavage (LL) of the abdominal cavity — in 3, non-operative treatment (NOT) with drainage of fluid collections — in 6, and only NOT in 10 patients. Most patients with distant or pericolic gas were operated on within an average time of 1 [0; 3.5] hours after admission. Diffuse peritonitis was detected during surgery in 45 (75%) of them. After resection, organ dysfunction of ≥ 2 points on the SOFA scale developed or progressed in 52 (86.7%) patients. The overall mortality rate was 48.7%, and the postoperative mortality was 63.3%. All patients (n = 38) died after segmental colon resection. Successful NOT was achieved in 4 patients with pericolic gas and 3 patients with distant gas.CONCLUSION: surgery for AICDD in patients with COVID-19 is associated with extremely high mortality, therefore, in the absence of obvious signs of diffuse peritonitis, initial non-operative treatment may be life-saving.

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Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

Cited by 3 publications

References 9 publications

The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case–control analysis of a retrospective multicentre database

The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case–control analysis of a retrospective multicentre database

Surgical Care under COVID-19 Pandemic Conditions (Literature Review)

Surgical and non-operative treatment of acute complicated diverticulitis in a COVID hospital

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