Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England

Abstract

Background This study assessed the impact of the first COVID-19 wave in England on outcomes for acute appendicitis, gallstone disease, intestinal obstruction, diverticular disease, and abdominal wall hernia. Methods Emergency surgical admissions for patients aged 18 years and older to 124 NHS Trust hospitals between January and June in 2019 and 2020 were extracted from Hospital Episode Statistics. The risk of 90-day mortality after admission during weeks 11–19 in 2020 (national lockdown) and 2019 (pre-COVID-19) was estimated using multilevel logistic regression with case-mix adjustment. The primary outcome was all-cause mortality at 90 days. Results There were 12 231 emergency admissions and 564 deaths within 90 days during weeks 11–19 in 2020, compared with 18 428 admissions and 542 deaths in the same interval in 2019. Overall, 90-day mortality was higher in 2020 versus 2019, with an adjusted OR of 1.95 (95 per cent c.i. 0.78 to 4.89) for appendicitis, 2.66 (1.81 to 3.92) for gallstone disease, 1.99 (1.44 to 2.74) for diverticular disease, 1.70 (1.13 to 2.55) for hernia, and 1.22 (1.01 to 1.47) for intestinal obstruction. After emergency surgery, 90-day mortality was higher in 2020 versus 2019 for gallstone disease (OR 3.37, 1.26 to 9.02), diverticular disease (OR 2.35, 1.16 to 4.73), and hernia (OR 2.34, 1.23 to 4.45). For intestinal obstruction, the corresponding OR was 0.91 (0.59 to 1.41). For admissions not leading to emergency surgery, mortality was higher in 2020 versus 2019 for gallstone disease (OR 2.55, 1.67 to 3.88), diverticular disease (1.90, 1.32 to 2.73), and intestinal obstruction (OR 1.30, 1.06 to 1.60). Conclusion Emergency admission was reduced during the first lockdown in England and this was associated with higher 90-day mortality.

Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic

“…These findings are consistent with prior studies revealing an increase in overall hospital mortality for non-COVID diseases during national lockdown periods [ 3 ], and for critically ill non-COVID-19 patients admitted to ICUs experiencing high rates of critical cases of COVID [ 15 , 26 ]. In the particular context of emergency and trauma surgery, higher mortality or failure to rescue also coincided with the peak months of the first wave [ 8 , 9 , 12 , 27 , 28 ]. Our study corroborates and goes beyond these results because it encompassed a much larger population of both elective and emergency surgeries, and considered pandemic exposure within every hospital countrywide throughout 2020.…”

Adapting Patient and Public Involvement processes in response to the Covid‐19 pandemic

“…10 , 11 The studies use Hospital Episode Statistics (HES) data to compare outcomes and costs of emergency surgery and other approaches to care (medical management, nonsurgical procedures or planned surgery). The initial NIHR‐funded ESORT Study ran from October 2019 to October 2021, with further funding awarded by The Health Foundation for ESORT‐C19 12 to assess the impact of the COVID‐19 pandemic on clinical management and outcomes of patients admitted to hospitals with these conditions.…”

Bridging the Gap: Investigating the Link between Inflammasomes and Postoperative Cognitive Dysfunction

“…These difficulties continue even if surgery is performed thirty days following a positive COVID-19 test [ 170 ]. In addition, patients undergoing surgery are more susceptible to infection with the COVID-19 virus because their immune systems are depressed due to surgical damage [ 171 ].…”