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?

Abstract

Introduction

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.

Methods

Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (16 ^th February 2020 to 15 ^th March 2020), and after UK government advice (16 ^th March 2020 to 15 ^th April 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups.

Results

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.

Conclusion

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.

Highlights

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  The “lockdown” effect led to significantly fewer surgical admissions and surgical patients being admitted more acutely unwell.

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  Higher rate of complications and overall mortality for surgical patients during lockdown.

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  Early diagnosis, resuscitation and intervention with surgery is critical during the COVID-19 pandemic, especially for patients with GI obstruction or perforation.