Impact of the SARS-CoV-2 pandemic on emergency surgery services-a multi-national survey among WSES members

Abstract

Background: The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It's impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now.

Methods: A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients.

Results: Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients.

Conclusions: The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.

Keywords: Appendicitis; COVID-19; Cholecystitis; Emergency surgery; SARS-CoV-2; WSES.

Fig. 1

Qualification and position of the participants of The WSES COVID-19 emergency surgery survey

Fig. 2

Patient treatment during the SARS-CoV-2 pandemic. a In general, does your hospital treat COVID-19 patients? Answers: “Yes” in black (n = 87, i.e. 88.8%) and “No” in grey (n = 11, i.e. 11.2%). b Have you continued to treat surgical emergency patients during the SARS-CoV-2 pandemic? Answers: “Yes” in black (n = 93, i.e. 94.9%) and “No, patients were transferred to other hospitals” in grey (n = 5, i.e. 5.1%)

Fig. 3

Has the SARS-CoV-2 pandemic had any impact on the treatment of surgical emergency patients? Estimates by the collaborators from “No impact” to “Very strong impact”. Participants, whose hospitals were not involved in COVID-19 patient care, are depicted in grey

Fig. 4

Has there been a decrease in the number of surgical emergency patients entering your Hospital? If the participants reported a decrease, they were also asked to estimate the degree of the decrease in percentage in their hospital. Note that also surgical emergency care givers from hospitals, where no COVID-19 patients were treated regularly, reported a decrease of emergency surgical caseload. Participants, whose hospitals were not involved in COVID-19 patient care, are depicted in grey

Fig. 5

Impact of the SARS-Co-2 pandemic on “time-to-diagnosis” and “time-to-intervention” in surgical emergency patients. Participants, whose hospitals were not involved in COVID-19 patient care, are depicted in grey. a Has there been a delay in the time from entering the hospital (e.g. with an intestinal perforation) to the diagnosis (“time-to-diagnosis”)? If the participants reported a delay, they were also asked to estimate the delay, e.g. from entering the hospital until the timepoint of computer tomography. b Has there been a delay in the time-from-diagnosis (e.g. of an intestinal perforation in the CT-scan) to the beginning of surgical intervention (“time-to-intervention”)? If the participants reported a delay, they were also asked to estimate the delay from diagnosis to surgical intervention

Fig. 6

The most important factor, leading to an enlarged time-to-intervention during the SARS-CoV-2 pandemic. Participants, whose hospitals were not involved in COVID-19 patient care, are depicted in Grey. n.a. = no answer. Lack in OR (operating room) staff, OR capacities and ICU (intensive care unit) capacities were stated as the reasons for a delay in time-to-intervention by 7.1%, 15.3% and 12.2% of the responders, respectively. Notably, problems with in-hospital logistics (e.g. transport of patients, closed normal wards et cetera) were seen as the most important factors for a delayed time-to-intervention in surgical emergency patients by the majority (50%) of the participants

Fig. 7

Has there been the need of a triage of emergency patients due to limited capacities during the SARS-CoV-2 pandemic? Answers: “Yes” in black (n = 55, i.e. 56.1%) and “No” in grey (n = 42, i.e. 42.9%). No answer was given by one participant

Fig. 8

Did you observe an increased relative number of perforated appendicitis/perforated diverticulitis/severe septic cholecystitis during the SARS-CoV-2 pandemic? Overall, 56.1% of the study group subjectively observed more severe septic abdominal diseases during the SARS-CoV-2 pandemic. Answers: “Yes” in black and “No” in grey. No answer was given by one participant regarding the relative number of severe septic cholecystitis during the SARS-CoV-2 pandemic (depicted in white)