Impact of the COVID-19 pandemic lockdown on the utilization of acute surgical care in the State of Salzburg, Austria: retrospective, multicenter analysis

Presl, J; Varga, M; Mittermair, Christof; Mitterwallner, Stefan; Weitzendorfer, Michael; Gabersek, Ana; Borhanian, K; Heuberger, A.; Weiß, Helmut; Emmanuel, Klaus; Rahden, Bha von; Koch, Oliver

doi:10.1007/s10353-021-00692-1

Cited by 10 publications

(14 citation statements)

References 18 publications

(16 reference statements)

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“…A total of 334 potential articles were identified from the search of electronic databases. A total of 39 full-text articles were assessed for eligibility and 15 articles dated since 2019 were included in the study ( 11 – 25 ) ( Figure 1 ). Three research studies were conducted in Italy, three in Turkey, two in Spain, one in the United Kingdom, one in New Zealand, one in the United States, one in Egypt, one in Austria, one in Switzerland, and one in Ireland.…”

Section: Resultsmentioning

confidence: 99%

“…These results indicate that throughout the pandemic, there has been a slide tendency toward conservative management, whereas the surgical approach is less considered compared to the pre-COVID-19 period. Three studies, which only presented surgical data concerning acute cholecystitis management, reported, in total, 107 patients previously managed operatively vs. 68 patients during the pandemic ( 14 , 15 , 25 ). Another study showed that there was a shift toward the initial surgical approach of the patients ( 11 ).…”

Section: Resultsmentioning

confidence: 99%

“…As far as the complications are concerned, the majority of studies presented the complication rates based on the Clavien-Dindo classification ( Table 4 ). Three of the articles comparing COVID-19 and the pre-COVID-19 era did not clearly mention the complications of their management strategies ( 13 , 24 , 25 ). Perrone et al ( 15 ) did not report any significant difference between the two periods, as only one death occurred in the COVID-19 era.…”

Section: Resultsmentioning

confidence: 99%

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COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

et al. 2022

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IntroductionSince the beginning of the COVID-19 pandemic, many patients with clinically acute presentations have been approached differently. The fear of viral transmission along with the short period of study made patients delay their hospital visits and doctors reassess the approach of certain acute situations. This study aimed to assess the changes in the management of patients with acute cholecystitis before and during COVID-19.MethodsA systematic review of the literature using PubMed (MEDLINE), Scopus, and ScienceDirect databases was performed until 01 September 2021. Totally, two kinds of studies were included, those assessing the management of acute cholecystitis during COVID-19 and those comparing the periods before and during the pandemic. The outcomes recorded include management approaches, complications, and mean length of stay.ResultsA number of 15 eligible articles were included in the study. During the pandemic, six studies revealed a shift toward conservative management of acute cholecystitis and five of them reported that conservative management was opted in 73% of the patients. On the contrary, data from all studies revealed that the surgical approach was preferred in only 29.2% of patients. Furthermore, when comparing the periods before vs. during COVID-19, the conservative approach was reported in 36.3 and 43.2% before vs. during COVID-19, respectively, whereas surgical intervention was performed in 62.5% of patients before COVID-19 and 55.3% during the pandemic. The length of stay was delayed when a non-surgical approach was selected in most studies. Complications, mainly classified by the Clavien-Dindo scale, were higher in the pandemic period.ConclusionA tendency toward more conservative approaches was observed in most studies, reversing the previously used surgical approach in most cases of acute cholecystitis. In most of the examined cases during the COVID-19 pandemic, antibiotic treatment and percutaneous cholecystostomy were much more considered and even preferred.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

et al. 2022

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“…According to several study groups, pandemic lockdowns appeared to decrease the admission rate of general surgery emergencies [2-4], while others saw an increase in case load [5]. Recently, several groups (including one from our department) published data on a higher incidence of complicated appendicitis during the first SARS-CoV-19 lockdown that lasted from March 15 to May 31.…”

Section: Introductionmentioning

confidence: 99%

Management of Symptomatic Gallstone Disease during COVID-19 Lockdown in a High-Resource Setting: Is There a Need for Treatment Alterations?

et al. 2022

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Introduction: Cholecystectomy (CCE) is the treatment of choice of symptomatic gallstones. Due to the SARS-CoV-2 pandemic, operating room (OR) capacities have been reduced. The goal of this study was to evaluate the duration of symptoms of patients presenting with gallstone disease during a lockdown, the surgical management, and the severity grade of their disease. Materials and Methods: A cohort study of 353 CCEs performed at a university hospital over two 10-week periods during 2 pandemic lockdowns in Germany compared to corresponding periods in 2018 and 2019. Results: During the lockdowns, 101 CCEs were performed compared to 252 in the prior years. The number of elective CCEs was reduced to save OR capacities (p < 0.001), and the most common indication for CCE was acute cholecystitis. The median time to CCE after symptom onset was 3 days in both groups for acute cholecystitis. The severity of cholecystitis was comparable (p = 0.760). The time to CCE after choledocholithiasis was shorter during the lockdowns (median of 4 days vs. 9 days; p = 0.006). Conclusions: The incidence and severity of acute cholecystitis during the lockdowns were comparable to the prior years. Acute care surgery was provided at the expense of elective procedures, and there was no need for treatment alterations.

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“…During the COVID-19 pandemic, general and emergency surgery has faced tremendous challenges due to the burden of critical respiratory patients in intensive care units (ICUs). This situation has forced the adoption of alternative strategies such as patient prioritization and avoidance or procrastination of elective surgical procedures [1][2][3]. Furthermore, management of surgical emergencies has changed, with the recommendation to postpone surgical treatment in the absence of life-threatening conditions.…”

Section: Introductionmentioning

confidence: 99%

Ventral hernia repair under neuraxial anesthesia

et al. 2021

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Background Acute strangulated ventral hernia is associated with operative morbidity and mortality. General anesthesia may increase the operative risk, especially in morbidly obese and COVID-19-positive individuals. Methods A 67-year-old woman with body mass index (BMI) 51 kg/m 2 , hospitalized for SARS-CoV-2-related interstitial pneumonia and renal failure, presented with acute abdominal pain, nausea, vomiting, and abdominal tenderness secondary to giant ventral hernia strangulation. Results Due to the suspicion of vascular bowel compromise at contrast-enhanced CT scan, urgent open surgical repair surgery was performed under spinal anesthesia and Venturi mask support. There was no need for an intensive care unit (ICU) stay. Postoperative course was uneventful, and the patient was transferred to a rehabilitation center on postoperative day 10. Conclusion Although some anesthetists and surgeons may be reluctant to use regional anesthesia for both emergent and elective ventral hernia repair, this may represent an excellent option in obese patients with a high respiratory risk.

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Impact of the COVID-19 pandemic lockdown on the utilization of acute surgical care in the State of Salzburg, Austria: retrospective, multicenter analysis

Cited by 10 publications

References 18 publications

COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

Management of Symptomatic Gallstone Disease during COVID-19 Lockdown in a High-Resource Setting: Is There a Need for Treatment Alterations?

Ventral hernia repair under neuraxial anesthesia

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