Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3691-3696
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3691
Emergency surgery in COVID-19 outbreak: Has anything changed? Single center experience
Francesco D'Urbano, Nicolò Fabbri, Margherita Koleva Radica, Eleonora Rossin, Paolo Carcoforo
Francesco D'Urbano, Margherita Koleva Radica, Eleonora Rossin, Paolo Carcoforo, Department of Morphology, Experimental Medicine and Surgery, Section of General Surgery, University of Ferrara, Ferrara 44100, Italy
Nicolò Fabbri, Unit of General Surgery, Azienda Unità Sanitaria Locale di Ferrara, Ferrara 44100, Italy
Author contributions: D'Urbano F, Fabbri N, Carcoforo P were involved in the study conceptualization, data curation, funding acquisition, investigation, project administration, supervision of the study, provision of resources and writing of the original draft; D'Urbano F, Fabbri N, Koleva Radica M, Rossin E, Carcoforo P were performed the data curation and formal analysis, and participated in the investigation, methodology design, software utilization, data visualization, and writing, review and editing of the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Area Vasta Emilia Centro, Italy.
Informed consent statement: Patients were not required to give informed consent to the study because the high risk of biological contamination. The analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nicolò Fabbri, MD, Surgeon, Unit of General Surgery, Azienda Unità Sanitaria Locale di Ferrara, Via Arturo Cassoli, 30, Ferrara, Ferrara 44100, Italy. n.fabbri@ausl.fe.it
Received: May 23, 2020
Peer-review started: May 23, 2020
First decision: June 19, 2020
Revised: July 22, 2020
Accepted: August 27, 2020
Article in press: August 27, 2020
Published online: September 6, 2020
Processing time: 104 Days and 1.9 Hours
Abstract
BACKGROUND

The current coronavirus disease 19 (COVID-19) pandemic is changing the organization of health care and has had a direct impact on the management of surgical patients.At the General Surgery Department of Sant’Anna University Hospital in Ferrara, Italy, surgical activities were progressively reduced during the peak of the COVID-19 outbreak in Italy. During this period, only one operating room was available for elective cancer surgeries and another for emergency surgeries. Moreover, the number of beds for surgical patients had to be reduced to provide beds and personnel for the new COVID-19 wards.

AIM

To compare 2 different period (from March 9 to April 9 2019 and from March 9 to April 9 2020), searching differences in terms of number and type of interventions in emergency surgery of a main University Hospital in Ferrara, a city in Emilia Romagna region, North of Italy.

METHODS

This retrospective study was carried out at the General Surgery Department of Sant’Anna University Hospital in Ferrara, Italy. We examined the number of emergency surgeries performed and patient outcomes during the peak of the COVID-19 outbreak in Italy and subsequent total lockdown. We then drew a comparison with the number of surgeries performed and their outcomes during the same period in 2019. The study examined all adult patients who underwent emergency surgery from March 9 to April 9, 2019 (n = 46), and those who underwent surgery during the first month of the lockdown, from March 9 to April 9, 2020 (n = 27). Analyses were adjusted for age, gender, American Society of Anesthesiologists classification scores and types of surgery.

RESULTS

A total of 27 patients underwent emergency surgery at Sant’Anna University Hospital in Ferrara during the first month of the lockdown. This represents a 41.3% reduction in the number of patients who were hospitalized and underwent emergency surgery compared to the same period in 2019. The complication rate during the pandemic period was substantially higher than it was during the analogous period in 2019: 15 out of 27 cases from March 9 to April 9, 2020 (55) vs 17 out of 46 cases from March 9 to April 9, 2019 (36.9). Of the 27 patients who underwent emergency surgery during the pandemic, 10 were screened for COVID-19 using both thorax high resolution computerized tomography and a naso-pharyngeal swab, while 9 only underwent thorax high resolution computerized tomography. Only 1 patient tested positive for SARS-CoV-2 and died following surgery.

CONCLUSION

There was a significant reduction in emergency surgeries at our center during the COVID-19 pandemic, and it is plausible that there were analogous reductions at other centers across Italy.

Keywords: COVID-19; Emergency surgery; Outbreak

Core tip: The current coronavirus disease 19 pandemic is changing the organization of health care and has had a direct impact on the management of surgical patients. In this article, we highlight how this outbreak could change the flow of surgical patients for many reasons, compared to the same period before pandemic in the main University hospital with an urban population. Data were retrospectively collected using SAP (Systeme, Anwendungen, Produkte in der Datenverarbeitung) database and the Ormaweb (Dedalus Spa) operating registry. There was a significant reduction in emergency surgeries at our center and it is plausible that an analogous reduction will occur in other hospitals.