World Journal of Emergency Surgery (Jul 2021)

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

  • Francesco A. Ciarleglio,
  • Marta Rigoni,
  • Liliana Mereu,
  • Cai Tommaso,
  • Alessandro Carrara,
  • Gianni Malossini,
  • Saverio Tateo,
  • Giuseppe Tirone,
  • Truls E. Bjerklund Johansen,
  • Pier Paolo Benetollo,
  • Antonio Ferro,
  • Giovanni Maria Guarrera,
  • Mario Grattarola,
  • Giandomenico Nollo,
  • Alberto Brolese

DOI
https://doi.org/10.1186/s13017-021-00382-z
Journal volume & issue
Vol. 16, no. 1
pp. 1 – 9

Abstract

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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.

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