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

Abstract

BACKGROUND: The aim of this retrospective comparative study was to assess the impact of the COVID-19 related disease on emergency surgery, comparing clinical main outcomes in the period March –May 2019 (Group 1) with the same period in Covid-19 Italian lockdown (March-May 2020, Group 2).METHODS: A comparison (Group 1 versus 2) was performed between the demographic, anamnestic, surgical, clinical and management features.RESULTS: 246 patients were included, 137 in Group 1 and 109 in Group 2 (p=0.03). No significant differences in peri-operative characteristics were registered. A declared delay in access to hospital and SARS-CoV-2 preoperatively infection rates were 15.5% and 5.8% respectively in Group 2. The overall morbidity (OR=2.22, 95%CI=1.08-4.55, p=0.03) and 30-day mortality (OR=1.34, 95%CI=0.33-5.50, =0.68) increased significantly in Group 2. Delayed access cohort demonstrated a close correlation with increased morbidity (OR=3.19, 95%CI=0.89-11.44, p=0.07), blood transfusion (OR=5.13, 95%CI=1.05-25.15, p=0.04) and a 30-day mortality risk (OR=8.00, 95%CI=1.01-63.23, p=0.05). Positive SARS-CoV-2 patients had higher risk of blood transfusion (20% vs 7.8%, p= 0.37), ICU admissions (20% vs 2.6%, p= 0.17) and median LOS (9 days vs 4 days, p= 0.11). CONCLUSIONS: This article provides enhanced understanding of the effects of the COVID-19 pandemic on patients access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. A delayed Emergency Department access and a “filter effect” induced by a COVID-fear in the population resulted in only the most severe cases reaching the Emergency Department in time.