ORIGINAL ARTICLE   

Minerva Surgery 2022 February;77(1):22-9

DOI: 10.23736/S2724-5691.21.08851-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Repercussions of COVID-19-related national lockdown on Emergency Surgery Department: a longitudinal cohort monocentric study

Giovanni CASELLA ¹, Lidia CASTAGNETO-GISSEY ¹ ✉, Ilario LATTINA ¹, Paolo FERRARI ², Alessandra IODICE ¹, Chiara TESORI ¹, Marco CATANI ², Marco ASSENZA ², Andrea MINGOLI ², Filippo LA TORRE ²

¹ Department of Surgical Sciences, Sapienza University, Rome, Italy; ² Emergency Surgery Department, Sapienza University, Rome, Italy

BACKGROUND: COVID-19 lockdown restrictions in conjunction with the pervasive hospital fear endured by the vast majority of the population played a fundamental role in discouraging access to emergency departments (EDs). We aimed at investigating whether and how the COVID-19 outbreak limited the access to ED and affected urgent surgical activities during and immediately after the 2-month pandemic-related national lockdown.
METHODS: Data regarding patients who accessed to the surgical ED were retrospectively collected. Analyzed time-periods included: “pre-COVID-19 era,” “COVID-19 era” considered as the period of full national lockdown and “post-COVID-19 era” after easing of lockdown measures. Consecutive emergency surgical procedures and ED admissions before, during and after COVID-19-lockdown were retrieved and analyzed.
RESULTS: There was a significant decrease in overall ED admissions and in all-specialty surgical consultations (P<0.01) throughout the outbreak. Once national lockdown was eased, we recorded a subsequent rebound 5-fold rise of emergency surgical procedures compared to COVID-19 group (P=0.011). Time-to-surgery was significantly greater in “COVID-19 era” and “post-COVID-19 era” compared to “pre-COVID-19” group (22.56±4.78, 75.99±15.89 and 16.73±1.76 hours, respectively) (P<0.01). A raised incidence of postoperative complications emerged in the “COVID-19 era” group (37.5%) compared to pre- and post-COVID groups (9.1% and 12.5%, respectively; P<0.001). Mortality rate in the “COVID-19 era” was 31.3% and 7.5% in “post-COVID-19” group (<0.0001).
CONCLUSIONS: This study demonstrates the major reduction of emergency surgical procedures and overall, ED admissions caused by COVID-19 pandemic. The raised rate of postoperative complications and mortality might be likely due to the superior severity of surgical conditions observed in the “COVID-19 era” subjects together with a probable deferred pursuit of medical attention.

KEY WORDS: COVID-19; Pandemics; SARS-CoV-2