Main Article Content
Surgery, Urgent surgery, COVID-19, Pandemic Phases.
Background and aim This study analyses the impact of the first two pandemic waves on surgical urgencies/emergencies and their consequences on an entire provincial hospital network's surgical activities.
Methods Clinical and epidemiological data of urgent/emergent surgical admissions and interventions in the Autonomous Province of Trento's hospital network were collected from the internal common electronic database. The investigation periods were March-May 2019 (reference period), March-May 2020 (phase-I), June - August 2020 (phase-II), and October - December 2020 (phase-III). The same data were divided and grouped for the six most represented diagnoses.
Results: The number of admissions for surgical emergencies in the studied periods showed a sinusoidal trend. In the reference period of 2019, 957 patients were admitted in urgency, while in the three pandemic phases, urgent admissions were 511, 888 and 633 respectively (-47% in phase I, - 8% in phase II, -34% in phase III). This trend was also observed by stratifying admissions for single disease, except for gastrointestinal perforations and pancreatitis, which showed a slight increasing trend in phase-I. Among the studied population, the surgical rate was 35.2% in phase-I and 34.3% in phase-III; these data were significantly higher than in 2019 (25.6%).
Conclusions The effect of the COVID pandemic on surgical emergencies and urgencies (SUEs) was mainly indirect, manifesting itself with a significant reduction in the number of surgical admissions, particularly in phases-I and-III. Conversely, in the same phases, the surgical rate showed a significant increase compared to 2019.
2. Rausei S, Ferrara F, Zurleni T, Frattini F, Chiara O, Pietrabissa A, Sarro G. Dramatic decrease of surgical emergencies during COVID-19 outbreak. 6, 2020, J Trauma Acute Care Surg, Vol. 89, p. 1085-91.
3. R, Jones. Hospital bed occupancy demystified. 6, 2011, British Journal of Healthcare Management , Vol. 17, p. 242-248.
4. Di Marzo F, Sartelli M, Cennamo R, Toccafondi G, Coccolini F, La Torre G, Tulli G, Lombardi M, Cardi M. Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2). 2020, Br J Surg, Vol. 17, p. 1104–1106.
5. De Simone B, Chouillard E, Di Saverio S, et al. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. 5, 2020, Ann R Coll Surg Engl. , Vol. 102, p. 323–332.
6. pandemic., COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19. Br J Surg. [published online April 15, 2020]. doi:10.1002/bjs.11646..
7.EpiCentro - Istituto Superiore della Sanità - L'epidemiologia per la sanità pubblica - ISS. [Online] https://www.epicentro.iss.it/passi/.
8. Gruppo Tecnico Nazionale PASSI e PASSI d’Argento, Istituto Superiore di sanità. https://www.epicentro.iss.it/passi-argento/pdf2020/PASSI-PdA-COVID19-p. PASSI e PASSI d’Argento e la pandemia COVID-19 - Primo Report nazionale dal Modulo COVID. [Online] 12 2020.
9. Dr Rob Findlay, Director, Gooroo Limited. ECIST guidance - NHS England and NHS Improvement. Planning beds, bed occupancy and risk. [Online] Version number: 1.0, May 2019. https://gooroo.co.uk/wp-content/uploads/2019/08/Planning_beds_bed_occupancy_and_risk.pdf.
10. AD, Keegan. Hospital bed occupancy: More than queuing for a bed. 5, September 2010, The Medical journal of Australia, Vol. 193, p. 291-3.
11. Kaier K, Mutters NT, Frank U. Bed occupancy rates and hospital-acquired infections-should beds be kept empty? 10, June 2012, Clinical Microbiology and Infection, Vol. 18, p. 941-5.
12. Ugglas BA, Djärv T, Ljungman PLS, Holzmann MJ. Association Between Hospital Bed Occupancy and Outcomes in Emergency Care: A Cohort Study in Stockholm Region, Sweden, 2012 to 2016. 2, Aug 2020, Ann Emerg Med, Vol. 76, p. 179-190.