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?
Adult
Aged
Aged, 80 and over
COVID-19
/ prevention & control
Cohort Studies
Emergencies
Facilities and Services Utilization
/ trends
Female
Follow-Up Studies
General Surgery
/ trends
Hospitalization
/ trends
Humans
Male
Middle Aged
Prospective Studies
Retrospective Studies
Severity of Illness Index
Surgical Procedures, Operative
/ mortality
United Kingdom
COVID-19
Emergency surgery
Lockdown effect
Severity
Volume
Journal
International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
11
07
2020
revised:
08
08
2020
accepted:
05
09
2020
pubmed:
16
9
2020
medline:
15
12
2020
entrez:
15
9
2020
Statut:
ppublish
Résumé
The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible 'lockdown' effect on the volume and severity of surgical admissions and their outcomes. Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (February 16, 2020 to March 15, 2020), and after UK government advice (March 16, 2020 to April 15, 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. There appears to be a "lockdown" effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic.
Identifiants
pubmed: 32931980
pii: S1743-9191(20)30674-9
doi: 10.1016/j.ijsu.2020.09.011
pmc: PMC7486821
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
259-266Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of competing interest Nil.
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