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. 2022 May 2.
doi: 10.1016/j.rgmx.2022.02.004. Online ahead of print.

[Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area]

[Article in Spanish]
M Mudarra Vela  1 , F Rivas Ruiz  1   2 , J Atienza Carrasco  1 , F J Medina Cano  1   2
Affiliations

[Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area]

[Article in Spanish]
M Mudarra Vela et al. Rev Gastroenterol Mex. .

Abstract
in English, Spanish

Introduction and aims: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic.

Materials and methods: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared.

Results: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6, [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died.

Conclusions: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

Introducción y objetivos: La perforación gastrointestinal es una emergencia quirúrgica asociada a una alta mortalidad que precisa cuidados avanzados. Durante la pandemia ha competido con los pacientes de COVID-19 por los recursos sanitarios, especialmente por la disponibilidad de camas en UCI.

El objetivo principal del estudio fue comparar la incidencia de perforación gastrointestinal durante la pandemia por COVID-19 con los casos registrados en prepandemia.

Material y métodos: Estudio retrospectivo observacional de cohortes unicéntrico, que incluyó a los pacientes intervenidos de urgencia por perforación gastrointestinal en periodos de pandemia (seis meses) y prepandemia (12 meses). Se compararon características sociodemográficas, comorbilidad, tiempos de ingreso hospitalario y en UCI, situación al alta y localización de la perforación.

Resultados: Se incluyeron a 67 sujetos (33 en prepandemia y 34 en pandemia). No hubo diferencias significativas con respecto al sexo, edad o comorbilidad. La razón de tasas de perforación por intervenciones urgentes fue cuatro veces mayor durante la pandemia. Aumentaron el número de extranjeros; 4 (11%) y no residentes; 6 (17%). Los ingresos en UCI disminuyeron (6 [19%]), aunque su estancia se prolongó 137 horas. La estancia hospitalaria aumentó 5 días y la demora en la atención 4.5 horas. Aumentaron las perforaciones de intestino grueso (3 [8%]). La mortalidad fue mayor; 10 (29.4%) frente a 5 (15.2%). Hubo cuatro pacientes perforados COVID-19 positivos, todos ellos fueron a UCI y fallecieron.

Conclusiones: Durante la pandemia por COVID-19 hubo un aumento de la incidencia de perforaciones gastrointestinales en nuestra área de atención, con cuadros más evolucionados y mayor mortalidad.

Keywords: COVID-19; Emergency surgery; Gastrointestinal perforation; Pandemic.

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Figures

Figura 1
Figura 1
Distribución de las perforaciones según su localización. Los resultados se expresan en número de casos por periodo. Cada columna corresponde a una localización y cada segmento de las columnas a los casos de cada periodo en esa localización.
Figura 2
Figura 2
Distribución de las perforaciones según la causa. Los resultados se expresan en porcentaje de casos por periodo. Cada columna corresponde a una causa donde cada segmento indica el porcentaje de casos de cada periodo. En el pie de cada columna se especifica el número total de perforaciones (n) para dicha causa.
Figura 3
Figura 3
Perfil, antecedentes y evolución de pacientes COVID-19 positivos con perforación gastrointestinal en periodo de estudio (01/09/2020 a 28/02/2021). EPOC: enfermedad pulmonar obstructiva crónica; LET: limitación del esfuerzo terapéutico; SIDA: síndrome de inmunodeficiencia adquirida.
See this image and copyright information in PMC

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