Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital

Abstract

Introduction The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. Materials and methods This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. Results A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). Conclusion Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.

The Impact of COVID-19 pandemic Lockdown on the utilization of acute surgical care, retrospective, multicenter analysis

“…We have also observed a faster relocation of the Non-COVID patient's therapy to the outpatient setting, leading to a shorter median LOS of 3 days (reduction of 25%) in the examined period of 2020. The same trend was reported by Patel et al in his cohort with a signi cant reduction of LOS from 3 to 2 days (p = 0.04) [12].…”

“…Many different deviations of stated therapies, to minimize the risk of COVID-19 cross infection are being reported. Patel et al described shortly ago an increased consumption of a conservative antibiotic therapy for uncomplicated appendicitis, during the Lockdown in England [12]. This therapy is in the literature stated as a feasible and save option, but with an increased risk for appendicitis recurrence [13,14].…”

“…This therapy is in the literature stated as a feasible and save option, but with an increased risk for appendicitis recurrence [13,14]. Patel also reported a deviation from the guidelines and an exclusively use of a conservative therapy as a rst line treatment for acute cholecystitis [12,15].…”

Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology

“…Despite testing negative for SARS-CoV-2, CT fractures were more comorbid, less active and frailer than PCT patients, depicting an epidemiological shift. Such epidemiological changes have also been reported in other surgical specialties during the pandemic [23,24]. The degree of frailty and the number and severity of associated comorbidities have already been described as a useful tool to predict outcomes in elderly patients with COVID-19 [25].…”

A comparative study looking at trauma and orthopaedic operating efficiency in the COVID-19 era

“…COVID-19 has placed an unprecedented pressure on all aspects of the NHS 4 . Although the total number of surgical cases has decreased, there has been a constant demand on operating theatres across all surgical specialities 5 . Significant changes in OR pathways, personal protective equipment (PPE), and altered thresholds for both surgery and general anaesthesia, have led to a relatively unfamiliar OR environment.…”