Impact of the COVID-19 national lockdown on emergency general surgery: Auckland City Hospital's experience

Abstract

Background: The New Zealand Government announced a four-level COVID-19 alert system soon after the first confirmed case in the country. New Zealand moved swiftly to the highest alert level 4, described as lockdown, as the epidemic curve quickly accelerated. Auckland City Hospital saw a temporary change in acute surgical admissions. The aim of this study is to evaluate the impact of the national lockdown on emergency general surgery.

Methods: A retrospective analysis was performed of all patients admitted to Auckland City Hospital via the Acute Surgical Unit during lockdown from 26 March to 27 April 2020. A comparison group was collected from the 33 days prior to lockdown, 22 February to 25 March 2020.

Results: The number of admissions decreased by 26% (P-value 0.000). A 56.8% decrease in patients presenting with trauma was found (P-value 0.002). After exclusion of trauma patients, no statistical difference in discharge diagnosis was found. There was a 43.6% reduction in operations performed (P-value 0.037). There was a difference found in the management of appendicitis and cholecystitis (P-value 0.003). Median length of stay was decreased from 1.8 to 1.3 days (P-value 0.031).

Conclusion: Auckland City Hospital had a decrease in admissions and operations during the COVID-19 lockdown. These findings suggest people with serious pathology were staying at home untreated or being treated in the community. This is a snapshot of our experience in managing emergency general surgical patients in this unusual period.

Keywords: Acute Surgical Unit; COVID-19; emergency general surgery; national lockdown; pandemic.