French survey on a cohort of emergency general surgery modifications induced by lockdown of the SARS-CoV-2 pandemic

Abstract

Purpose: The brutal COVID-19 pandemic has majorly impacted populations and health systems, and surgeons have observed dramatic changes in their daily clinical activities. A survey of French digestive surgeons was conducted to assess these changes.

Methods: An electronic survey was sent to French digestive and general surgeons in the Societe Francaise de Chirurgie Digestive (SFCD) to assess the surgeons' daily activity during the pandemic and investigate changes in patients' management. The care deviations were classified as delay of management, modification of strategy, or modification of organization, and the impact of these changes on patients was evaluated by the surgeon's estimation of loss of chance.

Results: A major reduction in surgical elective activity was observed in 50 (75%) of the 67 hospitals that responded. Of these, 48 hospitals (71.6%) reported receiving SARS-CoV-2 patients. A deviation from usual care was observed in 10% of patients admitted for emergency general surgery. Among 140 patients presenting a deviation from usual care, 74 (52.9%) had delayed management, 53 (37.9%) had a modification of strategy, and 64 (45.7%) had a modification of organization. Medical treatment instead of surgical treatment was decided for 37 (26.4%) patients, resulting in a high loss of chance for 6 patients. Delays (p < 0.001) and a switch from surgical to medical treatment (p = 0.002) were independently correlated with overall loss of chance based on multivariate analysis.

Conclusion: This study highlighted the deviations in general emergency surgery patients and provided implications for the solutions that should be implemented during a new health crisis.

Keywords: Acute abdominal surgery; COVID-19; Digestive surgery; Loss of chance; SARS-CoV-2.

Fig. 1

Venn diagram representing the three different deviations. The wideness of the circles illustrates the number of events for each type of deviation. The circles cross when patients experienced two or more types of deviations.