CoVID-19 Pandemic consequences on emergency surgery: an observational case-control study from an Italian tertiary referral hospital

Abstract Background In 2020, on March the 9th, the Italian Prime Minister announced the lockdown, which was officially closed on May the 4th. This extraordinary measure was necessary to contain the CoVID-19 pandemic spread in Italy. During this phase, a significant decrease of patient’s access to Emergency Department (ED) was observed. Delayed access to treatment may have led to a delay in the diagnosis of acute conditions also in the surgical field, as already documented in other areas, with consequences on surgical outcome and survival.Aim of this study is to provide a detailed description of abdominal urgent-emergent conditions surgically treated and surgical outcomes during the lockdown in a tertiary referral Italian hospital, compared with historical data.MethodsA retrospective review of urgent-emergent patients surgically treated in our department was conducted in order to compare patients’ characteristics and surgical outcomes during the period March 9th - May 4th 2020 with the same period of the previous year. Results152 patients were included in our study, 79 patients in 2020 group and 77 patients in 2019. We found no significant differences between the groups about ASA score, age, gender and disease prevalence. Significant differences were found about symptoms duration before ER access and abdominal pain as main symptom in non-traumatic conditions. We also performed a sub-analysis on peritonitis which showed significant differences in: hospital length of stay, presence of colostomy vs ileostomy and fatal events in 2020. No differences were found in the use of laparoscopy. ConclusionsWhile the overall number of ER accesses has decreased in 2020 group, the number of patients surgically treated in emergency-urgency conditions has not decreased. However, those patients waited significantly more before the hospital access. This diagnostic delay was associated to a more severe clinical condition and a consequent significantly worse prognosis.