Impact of the COVID-19 Pandemic on Emergency Adult Surgical Patients and Surgical Services

Abstract

The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. Background: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. Methods: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. Results: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July. Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM. The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing. Conclusion:The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status. Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.

The impact of acute surgical unit rostering on National Emergency Access Targets during the COVID‐19 pandemic: a single hospital experience

“…There have been several published reports indicating an increase in delayed hospital presentations due to fear from contracting COVID‐19, resulting in more unwell patients at baseline and higher overall complication rates. 6 , 7 , 8 , 9 The ASA trend and complication rates seen in our study are also consistent with these findings.…”

Impact of the COVID‐19 pandemic on colorectal cancer surgery in Japan: Clinical Study Group of Osaka University―A multicenter retrospective study

“… 1 , 2 In response to the overwhelming spread of the SARS‐CoV‐2 outbreak and its disruption of healthcare systems, many governments worldwide imposed lockdowns or declared states of emergency to prevent its spread. 3 , 4 In Japan, the first case of COVID‐19 was confirmed in January 2020. That case was followed by outbreaks on board the Diamond Princess cruise ship, in February 2020, which resulted in 696 cases.…”

“…Subsequently, the disease spread rapidly around the world, which led to the COVID‐19 pandemic 1,2 . In response to the overwhelming spread of the SARS‐CoV‐2 outbreak and its disruption of healthcare systems, many governments worldwide imposed lockdowns or declared states of emergency to prevent its spread 3,4 . In Japan, the first case of COVID‐19 was confirmed in January 2020.…”

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“…The health system worldwide has faced a shortage of resources and personnel and consequent delays in providing emergency care [ 3 , 5 ]. During lockdown periods, outpatient schedules were postponed, resulting in the progression of many diseases [ 6 , 7 ]. Out-of-hospital cardiac arrest (OHCA) is one of the conditions that has been affected by overburdened health care systems [ 8 ].…”