Incidence of surgical abdominal emergencies during SARS-CoV-2 pandemic

Pérez-Rubio, Álvaro; Tomás, Juan Carlos Sebastián; Navarro-Martínez, Sergio; Guardiola, Paula Gonzálvez; Meroño, Daniel Guillermo Torrecillas; Pozo, Carlos Domingo del

doi:10.1016/j.cireng.2020.11.012

Cited by 14 publications

(19 citation statements)

References 14 publications

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“…While our findings are in line with current research elucidating a change in healthcare-seeking behaviors as a result of the pandemic, 6 , 7 , 8 , 9 , 20 , 21 , 22 , 23 , 24 we did not experience the increased severity of disease presentation that we predicted despite increased length of symptoms among those with Tokyo I disease. Tokyo I admissions decreased significantly after the pandemic declaration whereas severe cases (Tokyo II and III) remained stable.…”

Section: Discussionsupporting

confidence: 90%

“… 19 While overall emergency department visits declined, rates of patients presenting with surgical needs and number of surgical procedures performed was especially reduced. 20 , 21 , 22 , 23 , 24 This pattern was seen globally, with researchers in Spain, Italy, and Portugal reporting decreased rates of emergency department visits and surgical admissions. 6 , 7 , 9 Fear of contracting COVID-19 at the hospital and attempting to help ease the burden on the healthcare system were common postulations for reduced visits and admission rates during the pandemic.…”

Section: Discussionmentioning

confidence: 87%

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COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Vallès

Neufeld

Caron

et al. 2021

Journal of Surgical Research

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Background Acute cholecystitis is a common reason for emergency general surgery admission. The declaration of the COVID-19 pandemic may have resulted in treatment delays and corresponding increases in severity of disease. This study compared cholecystitis admissions and disease severity pre- and post-declaration of pandemic. Materials and Methods Retrospective review of adult acute cholecystitis admissions (1/1/20-5/31/20). Corresponding time periods in 2018 and 2019 comprised the historical control. Difference-in-differences analysis compared biweekly cholecystitis admissions pre- and post-declaration in 2020 to the historical control. Odds of increased severity of disease presentation were assessed using multivariable logistic regression. Results Cholecystitis admissions decreased 48.7% from 5.2 to 2.67 cases [RR 0.51(0.28,0.96), p=0.04] following pandemic declaration when comparing 2020 to historical control (p=0.02). After stratifying by severity, only Tokyo I admissions declined significantly post-declaration [RR 0.42(0.18,0.97)], when compared to historical control (p=0.02). There was no change in odds of presenting with severe disease after the pandemic declaration [aOR 1.00 (95% CI 0.30, 3.38) p<0.99] despite significantly longer lengths of symptoms reported in mild cases. Conclusion Post-pandemic declaration we experienced a significant decrease in cholecystitis admissions without corresponding increases in disease severity. The pandemic impacted healthcare-seeking behaviors, with fewer mild presentations. Given that the pandemic did not increase odds of presenting with increased severity of disease, our data suggests that not all mild cases of cholecystitis progress to worsening disease and some may resolve without medical or surgical intervention.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 87%

COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Vallès

Neufeld

Caron

et al. 2021

Journal of Surgical Research

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“…Respiratory complications occurred in 51.2% of the patients, with a mortality of 38%, which represents 82.6% of all deaths in the study [5]. Other series have also shown high mortality rates between 20 and 25%, with respiratory complications been reported in up to 40-50% of patients [6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

et al. 2021

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Background Severe acute respiratory syndrome due to coronavirus 2 has rapidly spread worldwide in an unprecedented pandemic. Patients with an ongoing COVID-19 infection requiring surgery have higher risk of mortality and complications. This study describes the mortality and morbidity in patients with perioperative COVID-19 infection undergoing elective and emergency surgeries. Methods Prospective cohort of consecutive patients who required a general, gastroesophageal, hepatobiliary, colorectal, or emergency surgery during COVID-19 pandemic at an academic teaching hospital. The primary outcome was 30-day mortality and major complications. Secondary outcomes were specific respiratory mortality and complications. Results A total of 701 patients underwent surgery, 39 (5.6%) with a perioperative COVID-19 infection. 30-day mortality was 12.8% and 1.4% in patients with and without COVID-19 infection, respectively (p \ 0.001). Major surgical complications occurred in 25.6% and 6.8% in patients with and without COVID-19 infection, respectively (p \ 0.001). Respiratory complications occurred in 30.8% and 1.4% in patients with and without COVID-19 infection, respectively (p \ 0.001). Mortality due to a respiratory complication was 100% and 11.1% in patients with and without COVID-19 infection, respectively (p \ 0.006). Conclusions 30-day mortality and surgical complications are higher in patients with perioperative COVID-19 infection. Indications for elective surgery need to be reserved for non-deferrable procedures in order to avoid unnecessary risks of non-urgent procedures.

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“…Non-surgical treatment mortality rate was 18.2% (p > 0.005). Median hospital stay was 16 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days, while median time from admission to COVID-19 diagnosis was 11 [8.2-21.75] days.…”

Section: Resultsmentioning

confidence: 99%

“…93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009.…”

mentioning

confidence: 99%

Multicentre cohort study of acute cholecystitis management during the COVID-19 pandemic

Caballero

González

Cuéllar

et al. 2021

Eur J Trauma Emerg Surg

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Purpose To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. Methods Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. Results Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49,, conservative treatment failure (OR 8.2,) and AC severity were associated with an increased odd of mortality. Conclusion In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.

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Incidence of surgical abdominal emergencies during SARS-CoV-2 pandemic

Cited by 14 publications

References 14 publications

COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

Multicentre cohort study of acute cholecystitis management during the COVID-19 pandemic

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