The effect of the COVID pandemic lockdown measures on surgical emergencies: experience and lessons learned from a Greek tertiary hospital

Abstract

Background The COVID-19 pandemic caused a rise in healthcare demands leading to significant restructuring of hospital emergency departments worldwide. The aim of the present study is twofold: firstly, to discern any differences in regard to reason for surgical emergency department (SED) attendance and hospital admission during the pandemic and pre-pandemic eras in Greece, and secondly, to assess the impact of the lockdown measures implemented during the pandemic on SED patient attendance. Methods Since the beginning of the COVID-19 pandemic in Greece (1 March 2020) and up to 15 December 2020, the charts of all adult patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A 1/3/2020 to 30/4/2020 and period D 16/10/2020 to 15/12/2020) and two interim (period B 1/5/2020 to 15/6/2020 and period C 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019. Results The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2019 to 1819 in 2020). During the first lockdown, there was statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). Contrarily, the rate of head injuries (p<0.001) and abdominal pain (p=0.04) were significantly increased. The same effect was observed regarding the rate of hospital admissions (p=0.002), although in terms of absolute numbers, admissions remained unchanged. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02). Overall, application of the lockdown led to a significant decrease in minor (p<0.001) and torso (p=0.001) injuries. Conclusion The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, SED attendance was significantly reduced during the pandemic, an effect that was even more pronounced during the lockdown implementation; nevertheless, the overall rate of hospital admissions remained the same, denoting that patient care was not altered.

Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital

“…[26,27]. In addition, the reduction in the number of emergency hernia repair surgeries reported is in line with previous studies [28]. We must point out that we compared the percentages within the two time periods of the emergency surgeries performed.…”

Impact of the COVID-19 pandemic on provision and outcomes of emergency abdominal surgery in Irish public hospitals

“…A limitation of any national administrative dataset is that hospital coding systems may not function optimally during a pandemic due to staff redeployment. Nonetheless, the 20% reduction identified in Ireland is remarkably consistent with observations from other health systems making this less likely [10,12]. There are gaps in our understanding of the fate of individuals considered for, but not ultimately undergoing, emergency surgery.…”

“…Reichert et al surveyed 98 collaborators from thirty-one countries with 87% of respondents reporting a decrease in the number of patients undergoing emergency surgery [11]. Reasons for this reduction in EAS could include patients avoiding healthcare facilities due to the risk of hospital-acquired SARS-CoV-2 infection [10,12,13], people being encouraged to stay at home [9,13], GPs favouring conservative measures instead of referring patients to ED [10,12], and possibly a more refined understanding of what constitutes a surgical 'emergency'. It is noteworthy that reductions happened during both waves, making it less likely that fear of the initially unknown impact of SARS-CoV-2 infection on surgical outcomes [22] or shortages of personal protective equipment were key factors.…”

“…It was anticipated that emergency surgery, usually necessitated by an acute threat to life or well-being that requires prompt treatment, would be impacted to a smaller extent [7]. The onset of the pandemic was marked by concern about the safety of surgery for patients and staff alike with a range of factors discouraging patients from seeking medical care [8][9][10][11][12][13]. As a result, admissions for emergency general surgery reduced in Europe and elsewhere [8-12, 14, 15].…”

COVID-19 Pandemic Impact on Orthopaedic Trauma Practice: A Global Perspective

“…Orthopaedic trauma consultations and admissions were not the only service that decreased during the pandemic. 41 The provision of other services, such as emergency room visits 42 and neurosurgical procedures 43 also decreased. One study revealed a 63.3% reduction in operative volume among general surgery patients.…”