The Reorganisation of Emergency General Surgery Services During the COVID-19 Pandemic in the UK: Outcomes of Delayed Presentation, Socio-economic Deprivation and Black, Asian and Minority Ethnic Patients

Overview

Journal Ann R Coll Surg Engl

Specialty General Surgery

Date 2022 May 31

PMID 35639022

Authors

A Chan

P Stathakis

P Goldsmith

S Smith

C Macutkiewicz

Affiliations

Soon will be listed here.

Abstract

Introduction: The COVID-19 pandemic is a global public health emergency. Lockdown restrictions and the reconfiguration of healthcare systems to accommodate an increase in critical care capacity have had an impact on 'non-COVID' specialties. This study characterises the utilisation of emergency general surgery (EGS) services during the UK lockdown period at a university teaching hospital with a catchment population that represents one of the most deprived and ethnically diverse areas in the UK.

Methods: EGS admissions during the UK lockdown period (March to May 2020) were compared with the same period in 2019. Patient demographics were recorded together with clinical presentation, hospital stay and treatment outcomes, and readmission data.

Results: The study included 645 patients, comprising 223 in the COVID-19 period and 422 in the non-COVID-19 period. There was no difference in age, sex, comorbidity or socio-economic status. A lower proportion of patients of Black, Asian and Minority Ethnicity (BAME) were admitted during the pandemic (20.6% vs 35.4%, < 0.05). The duration of symptoms prior to presentation was longer, and admission clinical parameters and serum inflammatory markers. More patients presented with an acute kidney injury (9.9% vs 4.7%, = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, = 0.023).

Conclusions: The reorganisation of EGS to a senior-led model has been successful in terms of outcomes and access to treatment despite a more unwell population. There was a significantly lower proportion of BAME admissions suggesting additional barriers to healthcare access under pandemic lockdown conditions.

References

Cano-Valderrama O, Morales X, Ferrigni C, Martin-Antona E, Turrado V, Garcia A . Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study. Int J Surg. 2020; 80:157-161. PMC: 7361112. DOI: 10.1016/j.ijsu.2020.07.002. View

Patel R, Hainsworth A, Devlin K, Patel J, Karim A . Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital. Ann R Coll Surg Engl. 2020; :1-6. PMC: 7388952. DOI: 10.1308/rcsann.2020.0147. View

. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020; 396(10243):27-38. PMC: 7259900. DOI: 10.1016/S0140-6736(20)31182-X. View

Ma X, Vervoort D, Reddy C, Park K, Makasa E . Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective. Int J Surg. 2020; 79:43-46. PMC: 7229460. DOI: 10.1016/j.ijsu.2020.05.037. View

Schuster K, Holena D, Salim A, Savage S, Crandall M . American Association for the Surgery of Trauma emergency general surgery guideline summaries 2018: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction. Trauma Surg Acute Care Open. 2019; 4(1):e000281. PMC: 6461136. DOI: 10.1136/tsaco-2018-000281. View

Pan D, Sze S, Minhas J, Bangash M, Pareek N, Divall P . The impact of ethnicity on clinical outcomes in COVID-19: A systematic review. EClinicalMedicine. 2020; 23:100404. PMC: 7267805. DOI: 10.1016/j.eclinm.2020.100404. View

Mayumi T, Okamoto K, Takada T, Strasberg S, Solomkin J, Schlossberg D . Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2017; 25(1):96-100. DOI: 10.1002/jhbp.519. View

Lv M, Luo X, Estill J, Liu Y, Ren M, Wang J . Coronavirus disease (COVID-19): a scoping review. Euro Surveill. 2020; 25(15). PMC: 7175649. DOI: 10.2807/1560-7917.ES.2020.25.15.2000125. View

Glasziou P, Sanders S, Hoffmann T . Waste in covid-19 research. BMJ. 2020; 369:m1847. DOI: 10.1136/bmj.m1847. View

10.

Aldridge R, Lewer D, Katikireddi S, Mathur R, Pathak N, Burns R . Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data. Wellcome Open Res. 2020; 5:88. PMC: 7317462. DOI: 10.12688/wellcomeopenres.15922.2. View

11.

Patriti A, Baiocchi G, Catena F, Marini P, Catarci M . Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life. World J Emerg Surg. 2020; 15(1):36. PMC: 7245630. DOI: 10.1186/s13017-020-00314-3. View

12.

OConnell R, Khan M, Amir M, Bucheeri M, Khan W, Khan I . The impact of COVID-19 on emergency general surgery admissions and operative volumes: A single centre experience. Surgeon. 2020; 19(5):e207-e212. PMC: 7674128. DOI: 10.1016/j.surge.2020.09.013. View

13.

Javanmard-Emamghissi H, Boyd-Carson H, Hollyman M, Doleman B, Adiamah A, Lund J . The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study. Tech Coloproctol. 2020; 25(4):401-411. PMC: 7362319. DOI: 10.1007/s10151-020-02297-4. View

14.

Seretis C, Archer L, Lalou L, Yahia S, Katz C, Parwaiz I . Minimal impact of COVID-19 outbreak on the postoperative morbidity and mortality following emergency general surgery procedures: results from a 3-month observational period. Med Glas (Zenica). 2020; 17(2):275-278. DOI: 10.17392/1229-20. View

15.

Salminen P, Tuominen R, Paajanen H, Rautio T, Nordstrom P, Aarnio M . Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. JAMA. 2018; 320(12):1259-1265. PMC: 6233612. DOI: 10.1001/jama.2018.13201. View

16.

De Simone B, Chouillard E, Di Saverio S, Pagani L, Sartelli M, Biffl W . Emergency surgery during the COVID-19 pandemic: what you need to know for practice. Ann R Coll Surg Engl. 2020; 102(5):323-332. PMC: 7374780. DOI: 10.1308/rcsann.2020.0097. View

17.

Park M, Cook A, Lim J, Sun Y, Dickens B . A Systematic Review of COVID-19 Epidemiology Based on Current Evidence. J Clin Med. 2020; 9(4). PMC: 7231098. DOI: 10.3390/jcm9040967. View