Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 28;17(1):8.
doi: 10.1186/s13017-022-00407-1.

Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients

Giovanni D Tebala  1   2 , Marika S Milani  3 , Mark Bignell  4 , Giles Bond-Smith  4 , Christopher Lewis  4 , Roberto Cirocchi  5 , Salomone Di Saverio  6 , Fausto Catena  7 , Marco Scatizzi  8 , Pierluigi Marini  9 ; CovidICE-International Collaborative
Collaborators, Affiliations

Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients

Giovanni D Tebala et al. World J Emerg Surg. .

Abstract

Introduction: The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic.

Materials and methods: Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods.

Results: Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase.

Conclusions: Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

Keywords: Admission; Covid-19; Emergency surgery.

PubMed Disclaimer

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 or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Most common diagnoses (p = 0.23745). “Hot gallbladder” includes acute cholecystitis and refractory biliary colic. “Diverticulitis” includes complicated and uncomplicated acute diverticulitis. “SBO” is small bowel obstruction. “CRC” is colorectal cancer
See this image and copyright information in PMC

References

    1. Guidance for health system contingency planning during widespread transmission of SARS-CoV-2 with high impact on healthcare services. https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-guidan.... Last accessed 22 Dec 2021.
    1. Tebala GD, Bond-Smith G. Guidelines and recommendations during the Covid-19 pandemic: a word of caution. Am J Surg. 2020;220:1526–1527. doi: 10.1016/j.amjsurg.2020.06.005. - DOI - PMC - PubMed
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–349. doi: 10.1016/j.jclinepi.2007.11.008. - DOI - PubMed
    1. Aranda-Narvaez JM, Tallon-Aguilar L, Pareja-Ciurò F, Martin-Martin G, Gonzales-Sanchez AJ, Rey-Simo I, Tamayo-Medel G, Yanez-Benitez C, Costa-Navarro D, Monton-Condon S, Navarro-Soto S, Turegano-Fuentes F, Perez-Diaz MD, Ceballo-Esparragon J, Jover-Navalon JM, Balibrea JM, Morales-Conde S. Atencion dela urgencia quirurgica durante la pandemia COVID-19. Recomendaciones de la Asociation Espanola de Cirujanos. Cir Esp. 2020;98:433–441. doi: 10.1016/j.ciresp.2020.04.031. - DOI - PMC - PubMed
    1. Tebala GD, Lami M, Bond-Smith G. Laparoscopic surgery and the coronavirus disease 2019 pandemic: a word from a different hymn-sheet. J Trauma Acute Care Surg. 2021;89:e121. doi: 10.1097/TA.0000000000002843. - DOI - PMC - PubMed