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.

The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access / Ciarleglio, F. A.; Rigoni, M.; Mereu, L.; Tommaso, C.; Carrara, A.; Malossini, G.; Tateo, S.; Tirone, G.; Bjerklund Johansen, T. E.; Benetollo, P. P.; Ferro, A.; Guarrera, G. M.; Grattarola, M.; Nollo, G.; Brolese, A.. - In: WORLD JOURNAL OF EMERGENCY SURGERY. - ISSN 1749-7922. - 16:1(2021), p. 37. [10.1186/s13017-021-00382-z]

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

Rigoni M.;Grattarola M.;Nollo G.;
2021-01-01

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.
2021
1
Ciarleglio, F. A.; Rigoni, M.; Mereu, L.; Tommaso, C.; Carrara, A.; Malossini, G.; Tateo, S.; Tirone, G.; Bjerklund Johansen, T. E.; Benetollo, P. P.; Ferro, A.; Guarrera, G. M.; Grattarola, M.; Nollo, G.; Brolese, A.
The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access / Ciarleglio, F. A.; Rigoni, M.; Mereu, L.; Tommaso, C.; Carrara, A.; Malossini, G.; Tateo, S.; Tirone, G.; Bjerklund Johansen, T. E.; Benetollo, P. P.; Ferro, A.; Guarrera, G. M.; Grattarola, M.; Nollo, G.; Brolese, A.. - In: WORLD JOURNAL OF EMERGENCY SURGERY. - ISSN 1749-7922. - 16:1(2021), p. 37. [10.1186/s13017-021-00382-z]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11572/319956
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