Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID-19 pandemic

Lima, Diego Laurentino; Pereira, Xavier; Santos, D. C. dos; Camacho, Diego; Malcher, Flavio

doi:10.1007/s10029-020-02250-2

Cited by 32 publications

(28 citation statements)

References 5 publications

(9 reference statements)

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“…Interestingly, the number of emergency hernia repairs did not increase as expected, but rather showed a trend towards decreasing (Figs. 1, 2, 3), which was confirmed by other analyses [5].…”

Section: Dear Editorsupporting

confidence: 84%

Elective hernia surgery cancellation due to the COVID-19 pandemic

Köckerling

Kockerling

Schug-Paß

2020

Hernia

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Section: Dear Editorsupporting

confidence: 84%

Elective hernia surgery cancellation due to the COVID-19 pandemic

Köckerling

Kockerling

Schug-Paß

2020

Hernia

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“… 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%

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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“…Several authors, particularly in heavily affected countries, have also experienced a 40-86% decrease in nontraumatic surgical emergencies following the coronavirus outbreak. [9][10][11][12][13] Acute appendicitis represents the most common abdominal surgical emergency worldwide, and prehospital delay is an independent predictor of complicated disease, which may result in unnecessary morbidity and increased mortality. 14 We have documented a significant increase in the average time of symptom onset to hospital arrival during the pandemic period.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

Fonseca

Trindade

Filho

et al. 2020

The American Surgeon

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Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

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Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID-19 pandemic

Cited by 32 publications

References 5 publications

Elective hernia surgery cancellation due to the COVID-19 pandemic

Elective hernia surgery cancellation due to the COVID-19 pandemic

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

Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

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