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. 2021 Jul 13;16(1):37.
doi: 10.1186/s13017-021-00382-z.

The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

Francesco A Ciarleglio  1 , Marta Rigoni  2   3 , Liliana Mereu  4 , Cai Tommaso  5 , Alessandro Carrara  6 , Gianni Malossini  5 , Saverio Tateo  4 , Giuseppe Tirone  6 , Truls E Bjerklund Johansen  7   8   9 , Pier Paolo Benetollo  10 , Antonio Ferro  10 , Giovanni Maria Guarrera  10 , Mario Grattarola  10 , Giandomenico Nollo  2   3 , Alberto Brolese  11
Affiliations

The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

Francesco A Ciarleglio et al. World J Emerg Surg. .

Abstract

Background: The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March-May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March-May 2020, group 2).

Methods: A comparison (groups 1 versus 2) and subgroup analysis were performed between patients' demographic, medical history, surgical, clinical and management characteristics.

Results: Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08-4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33-5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89-11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05-25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01-63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11).

Conclusions: This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a "filter effect" induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

Keywords: COVID-19 disease; Complications; Delayed access; Emergency surgery; Surgical care.

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Conflict of interest statement

The authors declare that they have no competing interests. All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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