Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Abstract

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic.

Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine.

Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis.

Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years.

Keywords: Appendicitis; COVID-19; Capacity; Emergency; Emergency surgery; Pandemic; Quarantine; SARS-CoV-2; Time to intervention; WSES.

Fig. 1

Characteristics of the collaborators. Working continents of the WSES COVID-19 emergency surgery survey collaboration group (a). Experience and position (b) as well as medical speciality (c) of the collaborators. #multiple answers possible

Fig. 2

Hospital characteristics of the collaboration group. Volume and academic affiliation (a–c) of the hospitals as well as reported treatment capacities of COVID-19 patients (d)

Fig. 3

SARS-CoV-2 outbreaks and emergency surgery. Interruption of surgical emergency patient care in response to SARS-CoV-2 outbreaks (a, b) as well as reasons for interruption of surgical emergency patient care during the pandemic (c)

Fig. 4

The impact of the pandemic situation on emergency surgery. The estimated “global” impact of the pandemic on emergency surgery (a, b) and the effect of the pandemic situation on emergency surgical case load (c, d)

Fig. 5

Delays in surgical emergency patient care. Do the collaborators still observe delays in time-to-diagnosis (a, b) and time-to-intervention (c, d) in emergency surgery and the reasons behind these observations (e). ^#Lack of diagnostic capacities (e.g., computed tomography, endoscopy, etc.). ^§Persistent worse in-hospital logistics (e.g., transport of patients, closed normal wards, etc.)

Fig. 6

Factors leading to problems with surgical emergency patient care during the pandemic. Free-text answers in a word cloud from the collaborators collecting relevant factors, which lead to problems with surgical emergency patient care during the pandemic

Fig. 7

The effect of the pandemic on patient outcome. The impact of the SARS-CoV-2 pandemic on diseases requiring emergency surgery (a) and on outcome of surgical emergency patients (b)

Fig. 8

Paradigm shift in treatment modalities. Shift of treatment modalities due to the pandemic from a frequently intended surgical therapy before to a non-operative approach during the pandemic situation in patients with appendicitis (a, b), diverticulitis (c–e) and cholecystitis (f). ^#multiple answers possible

Fig. 9

Testing and quarantine strategies. Local testing (a) and quarantine strategies (b) varying strongly. (c) Which separated pathways are useful and which resources are provided by hospital management to separate SARS-CoV-2 positive from uninfected patients. ^#multiple answers possible. ^§Reserved diagnostic facilities (e.g., computed tomography scanner, ultrasonography, etc.)