The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis

Abstract

The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.

Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Increasing Incidence of Complicate Appendicitis, Severity and Length of Hospitalization

“…Our analysis, in parallel with studies published in the literature, showed an increased number of intraoperative findings (appendicular abscess, peritonitis and appendicular perforation) as well as higher staging of acute appendicitis on pathological examinations and higher inflammatory indices on blood tests during the pandemic (28,36). It has been described that patients presenting to the surgical department more than 1 day after the onset of signs and symptoms are at a higher risk of suffering from perforated appendicitis (43,44).…”

“…Nowadays, we begin to evaluate the first effects of COVID-19 on non-virus-related diseases (11,13,27). In fact, during this emergency period, even access to the surgical emergency department suffered a sharp decline (7,(28)(29)(30). Comparably with published data, in our analysis we recorded a reduction of roughly 40% in admissions to the emergency surgical department (28)(29)(30)(31)(32)(33)(34).…”

“…In fact, during this emergency period, even access to the surgical emergency department suffered a sharp decline (7,(28)(29)(30). Comparably with published data, in our analysis we recorded a reduction of roughly 40% in admissions to the emergency surgical department (28)(29)(30)(31)(32)(33)(34). Moreover, the fear of contracting COVID-19 as well as the encouragement by the authorities to avoid unnecessary presentations to the emergency department could explain the reduction in absolute numbers of accesses to the hospital (10,35).…”

Comparison of demographic and clinical characteristics between pandemic and pre-pandemic period in non-COVID intensive care units: a retrospective study

“…Deo et al reported that hospital admissions and surgeries for non-COVID-19 reasons decreased compared to the pre-pandemic period. [ 10 ] Yanaral and Öz reported that in the pandemic period, the number of patients undergoing emergency and elective surgery decreased compared to the pre-pandemic period. [ 11 ] Furthermore, Schöni et al, reported that surgical interventions decreased during the pandemic period.…”

Assessment of Compliance and Impact of the COVID-19 RSNA Recommendations on Radiology Departments: A French Survey

“…Third, a COVID-19–trained staff designated to work exclusively with infected patients was frequently not available. Indeed, reorganization of the entire radiography staff around a single disease can be challenging considering that other activities, such as emergency ( 4 ) and oncologic care ( 5 ), must be maintained.…”