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The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access
Francesco A Ciarleglio1, Marta Rigoni2,3, Liliana Mereu4
1General Surgery II & HPB Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Largo Medaglie d'Oro, 1, 38122, Trento, Italy. francesco.ciarleglio@apss.tn.it.
Insights
The COVID-19 pandemic negatively impacted emergency surgery outcomes, increasing morbidity and mortality. Delayed access to emergency departments due to fear of infection led to poorer patient prognoses.
Area of Science:
- Emergency Medicine
- Surgical Outcomes
- Infectious Diseases
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems globally.
- Access to emergency surgical care may have been affected by lockdowns and patient-related fears.
Purpose of the Study:
- To evaluate the impact of COVID-19 and delayed emergency department (ED) access on emergency surgery outcomes.
- To compare clinical outcomes between pre-pandemic (2019) and pandemic (2020) periods.
Main Methods:
- Retrospective comparative study of emergency surgery patients.
- Comparison of clinical outcomes between March-May 2019 and March-May 2020 (during COVID-19 lockdown).
- Analysis of demographic, clinical, and management characteristics.
Main Results:
- Higher overall morbidity (OR=2.22) and 30-day mortality (OR=1.34) were observed in the COVID-19 period (group 2).
- Delayed ED access was linked to increased morbidity (OR=3.19), need for blood transfusion (OR=5.13), and 30-day mortality risk (OR=8.00).
- Preoperative SARS-CoV-2 infection was associated with higher transfusion rates and ICU admissions.
Conclusions:
- COVID-19 pandemic altered surgical care quality, leading to poorer prognoses and higher morbidity.
- Delayed ED access, influenced by fear of SARS-CoV-2 infection, resulted in sicker patients presenting later.
- Findings highlight the critical need to maintain timely access to emergency surgical services during health crises.
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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