Impact of COVID-19 on common non-elective general surgery diagnoses

Caroline E Reinke; Huaping Wang; Kyle Thompson; B Lauren Paton; William Sherrill; Samuel W Ross; Lynnette Schiffern; Brent D Matthews

doi:10.1007/s00464-022-09154-5

Impact of COVID-19 on common non-elective general surgery diagnoses

Surg Endosc. 2023 Jan;37(1):692-702. doi: 10.1007/s00464-022-09154-5. Epub 2022 Mar 17.

Authors

Caroline E Reinke¹, Huaping Wang², Kyle Thompson², B Lauren Paton², William Sherrill², Samuel W Ross², Lynnette Schiffern², Brent D Matthews²

Affiliations

¹ Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC, 28205, USA. caroline.e.reinke@atriumhealth.org.
² Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC, 28205, USA.

Abstract

Background: During the COVID-19 pandemic, public health and hospital policies were enacted to decrease virus transmission and increase hospital capacity. Our aim was to understand the association between COVID-19 positivity rates and patient presentation with EGS diagnoses during the COVID pandemic compared to historical controls.

Methods: In this cohort study, we identified patients ≥ 18 years who presented to an urgent care, freestanding ED, or acute care hospital in a regional health system with selected EGS diagnoses during the pandemic (March 17, 2020 to February 17, 2021) and compared them to a pre-pandemic cohort (March 17, 2019 to February 17, 2020). Outcomes of interest were number of EGS-related visits per month, length of stay (LOS), 30-day mortality and 30-day readmission.

Results: There were 7908 patients in the pre-pandemic and 6771 in the pandemic cohort. The most common diagnoses in both were diverticulitis (29.6%), small bowel obstruction (28.8%), and appendicitis (20.8%). The lowest relative volume of EGS patients was seen in the first two months of the pandemic period (29% and 40% decrease). A higher percentage of patients were managed at a freestanding ED (9.6% vs. 8.1%) and patients who were admitted were more likely to be managed at a smaller hospital during the pandemic. Rates of surgical intervention were not different. There was no difference in use of ICU, ventilator requirement, or LOS. Higher 30-day readmission and lower 30-day mortality were seen in the pandemic cohort.

Conclusions: In the setting of the COVID pandemic, there was a decrease in visits with EGS diagnoses. The increase in visits managed at freestanding ED may reflect resources dedicated to supporting outpatient non-operative management and lack of bed availability during COVID surges. There was no evidence of a rebound in EGS case volume or substantial increase in severity of disease after a surge declined.

Keywords: COVID-19; Emergency general surgery; Pandemic.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Cohort Studies
Emergency Service, Hospital
General Surgery*
Hospitalization
Humans
Pandemics
Retrospective Studies