Lessons for Emergency Surgery in the Second Wave: One-Month Single-Centre Experience During the First Wave of COVID-19

摘要

Introduction The global COVID-19 pandemic had a deleterious effect upon elective and emergency surgery. Focus of patient care was directed to emergency services.?Association of Surgeons of Great Britain and Northern Ireland guidelines advised a trend towards conservative management.?Traditional surgical intervention was reserved only for selected cases only.?We evaluated our emergency practice over a four-week period during the first peak of COVID-19. Methods A retrospective single-centre analysis was performed of consecutive patients seen by the emergency general and vascular surgery on-call team in a District General Hospital over a four-week period (30 March 2020-26 April 2020).?Primary outcome was 30-day COVID-19 mortality.?Secondary outcomes were 30-day complications, readmission rate and non-COVID-19-related mortality. Adherence to intercollegiate guidelines was also assessed. Results A total of 184 patients were assessed during the period.?The median age was 55 years (interquartile range 34-75), with a male:female ratio of 1:0.7.?Thirty-day COVID-19- and non-COVID-19-related mortalities were 3% and 8%, respectively. Thirteen percent of patients developed complications and 9% represented to the emergency department within 30 days.?Conservative management was initially employed in 78% of patients.?This had success rates in appendicitis and cholecystitis of 72% and 75%, respectively.?A CT thorax was included in 89% having a CT abdomen and pelvis.?Thirty-eight percent had a COVID-19 polymerase chain reaction (PCR) swab test performed throughout the study period.?Fifty-two percent of individuals who underwent emergency surgery had a swab performed prior to operative intervention. Conclusions Conservative management seems to be reasonably effective and may re-shape the way we treat a proportion of surgical pathologies in the future.?Further long-term data are required in order to evaluate this. A paucity of PCR testing was due to nationwide capacity shortcomings.?This must be addressed in future peaks with rapid testing in order to triage patients to the appropriate setting.