Impact of COVID-19 on elective general surgery cancellations and emergency presentations

Following the declaration of the COVID-19 pandemic by the World Health Organization, many measures to contain its spread were applied in Australia, including the cancellation and postponement of elective procedures. This study aims to explore the impact of these delays to elective surgery on emergency department (ED) presentations and post-operative outcomes.

This was a single-centre retrospective cohort study comparing waitlisted elective general surgical patients presenting to ED between 2021 and 2023 to a pre-COVID cohort presenting between 2017 and 2019. The primary outcome was the incidence and proportion of ED presentations for waitlisted patients, with secondary outcomes of emergency surgical intervention and post-operative morbidity. SPSS Statistics version 24.0 (IBM SPSS Statistics for Windows, Amonk, NY, USA) was used for statistical analysis.

No significant difference in incidence of related ED presentations was found between the two groups (22.1% v 21.4%, P = 0.610). A significant increase in average waitlist time was seen in the post-COVID period, with delays to procedures for 51.5% of patients compared to 9.2% pre-COVID (<0.001). Average waitlist time for category 1 & 2 procedures in the post-COVID period was notably higher than the recommended category wait-time (category 1, 50.3 ± 43.1 days; category 2, 124.5 ± 106.8 days).

Significant delays to surgery and an increase in waitlist time were apparent in the post-COVID period despite no significant difference in emergency presentation incidence for waitlisted elective general surgical patients.