The effect of covid-19 pandemic on emergency general surgery cases: A single-center observational study

Yıl 2021, , 519 - 522, 01.05.2021

Mehmet Kağan Katar , Pamir Eren Ersoy

https://doi.org/10.28982/josam.912739

Öz

Background/Aim: Many people around the world have been affected by the COVID-19 pandemic. Some of them were directly affected as patients. However, even if some did not suffer from the disease, they may have been indirectly affected. The aim of this study was to investigate whether the COVID-19 pandemic has an impact on emergency general surgery admission volume and operations.
Methods: In this retrospective case-control study, all patients referred from the emergency department to our emergency general surgery unit between April 1 - May 31,2020 were evaluated. Patients over 18 years of age, who were hospitalized for longer than 24 hours and required evaluation and treatment by a general surgeon were included in the study. Patients with similar characteristics that were treated in our clinic in the same periods in 2018 and 2019 were evaluated as the control group.
Results: During the pandemic, a total of 208 patients were hospitalized in the emergency general surgery service. The number of admissions to the emergency general surgery service in 2020 was 25.9% less than that in 2018 and 30.8% less than that in 2019. During the pandemic, while there was a decrease in cases of non-specific abdominal pain and trauma (P=0.003, P=0.015, respectively), there was a significant increase in cases of gastrointestinal obstruction and perforation (P=0.001, P<0.001, respectively). The rate of surgery during the pandemic was 65.9%, which was significantly higher than the previous years (P<0.001). The rate of laparoscopic procedures decreased significantly during this period (P<0.001). The complication and mortality rates were significantly higher (P=0.004, P=0.025, respectively).
Conclusion: We observed that while emergency general surgery case applications, surgery rates, and hospital stay decreased during the COVID-19 pandemic, there was an increase in the rate of more serious diagnoses, complications, and mortality.

Anahtar Kelimeler

Covid-19, Pandemic, Emergency, General surgery, Outbreak

Kaynakça

• 1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-33.
• 2. Coronavirus disease 2019 (COVID-19) situation report - 51. World Health Organisation; 2020. Updated on March 11, 2020. https://apps.who.int/iris/bitstream/handle/10665/331475/nCoVsitrep11Mar2020-eng.pdf?sequence=1&isAllowed=y.
• 3. İçişleri Bakanlığı ‘Coronavirüs Tedbirleri Konulu Genelge’. Updated on March 16, 2020. https://www.icisleri.gov.tr/81-il-valiligine-koronavirus-tedbirleri-konulu-ek-genelge-gonderildi.
• 4. İçişleri Bakanlığı ‘Koronavirüs Tebdirleri Kapsamında Şehirlerarası Otobüs Yolcu Taşımacılığı İle İlgili Ek Genelge’. Updated on March 28, 2020. https://www.icisleri.gov.tr/koronavirus-tebdirleri-kapsaminda-sehirlerarasi-otobus-yolcu-tasimaciligi-ile-ilgili-ek-genelge.
• 5. İçişleri Bakanlığı ‘Şehir Giriş/Çıkış Tebirleri ve Yaş Sınırlaması Konulu Genelge’. Updated on April 3, 2020. https://www.icisleri.gov.tr/sehir-giriscikis-tebirleri-ve-yas-sinirlamasi.
• 6. İçişleri Bakanlığı ‘2 Gün Sokağa Çıkma Yasağı Konulu Genelge’. Updated on 10, 2020. https://www.icisleri.gov.tr/2-gun-sokaga-cikma-yasagi.
• 7. Sağlık Bakanlığı ‘Pandemi Hastaleri Konulu Genelge’. Updated on March 20, 2020. https://hasta.saglik.gov.tr/Eklenti/36907/0/pandemi-hastaneleripdf.pdf.
• 8. Sağlık Bakanlığı ‘Elektif İşlemlerin Ertelenmesi ve Diğer Alınacak Tedbirler Konulu Genelge’. Updated on March 17, 2020. https://hasta.saglik.gov.tr/Eklenti/36865/0/elektif-islemlerin-ertelenmesi-ve-diger-tedbirlerpdf.pdf.
• 9. Mantica G, Riccardi N, Terrone C, Gratarola A. Non COVID-19 visits to emergency departments during the pandemic: the impact of fear. Public Health. 2020;183:40–1.
• 10. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020;4:e10–1.
• 11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
• 12. McGuinness MJ, Hsee LI. Impact of the COVID-19 national lockdown on emergency general surgery: Auckland City Hospital's experience. ANZ J Surg. 2020;90:2254-8.
• 13. Dick L, Green J, Brown J, Kennedy E, Cassidy R, Othman S, et al. Changes in emergency general surgery during COVID-19 in Scotland: a prospective cohort study. World J Surg. 2020;44:3590-4.
• 14. Mauro V, Lorenzo M, Paolo C, Sergio H. Treat all COVID 19- positive patients, but do not forget those negative with chronic diseases. Intern Emerg Med. 2020;15:787-90.
• 15. McLean RC, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, et al. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: is there a ‘lockdown’ effect? Int J Surg. 2020;83:259–66.
• 16. American College of Surgeons, COVID-19 guidelines for triage of emergency general surgery patients. https://www.facs.org/covid-19/clinical-guidance/elective-case/emergency-surgery (accessed 20 March 2020).
• 17. Intercollegiate Surgical Colleges, Updated General Surgery Guidanceon COVID-19. Updated on March 26, 2020. https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/.
• 18. Haijanen J, Sippola S, Grönroos J, Rautio T, Nordström P, Rantanen T, et al. Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). BMC Surg. 2018;18:117.