Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients
Authors: Tebala Giovanni D. , Milani Marika S. , Bignell Mark , Bond-Smith Giles , Lewis Christopher , Cirocchi Roberto , Di Saverio Salomone , Catena Fausto , Scatizzi Marco , Marini Pierluigi ,   the CovidICE-International Collaborative, Lo Dico Rea , Stracqualursi Antonio , Russo Giuseppe , D’Errico Sara , Cianci Pasquale , Restini Enrico , Scialandrone Grazia , Guercioni Gianluca , Martinez Gennaro , Pezzolla Angela , Altomare Donato F. , Picciariello Arcangelo , Trigiante Giuseppe , Dibra Rigers , Papagni Vincenzo , Righetti Carolina , Polastri Roberto , Andreuccetti Jacopo , Pignata Giusto , D’Alessio Rossella , Arici Elisa , Canfora Ilaria , Cillara Nicola , Deserra Antonello , Sechi Raffaele , Bianco Francesco , Gili Simona , Cappiello Antonio , Incollingo Paola , Biloslavo Alan , Bellio Gabriele , Germani Paola , De Manzini Nicolò , Buiatti Marco , Paladino Fabio P. , Sasia Diego , Borghi Felice , Testa Valentina , Giraudo Giorgio , Allisiardi Fabrizio , Giuffrida Maria C. , Gerosa Martino , Fogliati Alessandro , Maggioni Dario , Fabbri Nicolò , Feo Carlo V. , Bianchini Erica , Panzini Ilaria , Lizzi Vincenzo , Tricarico Fausto G. , Di Gioia Giovanni , Melino Rocco , Tartaglia Nicola , Ambrosi Antonio , Pavone Giovanna , Pacilli Mario , Vovola Fernanda , Belli Fiorenza , Barberis Andrea , Azzinnaro Antonio , Coratti Andrea , Benigni Roberto , Berti Stefano , Saracco Michele , Gennai Andrea , Dova Laura , Farfaglia Roberto , Pata Giacomo , Arizzi Valeria , Pandolfo Giampiero , Frontali Alice , Danelli Piergiorgio , Ferrario Luca , Guerci Claudio , Mariani Nicolò M. , Pisani Ceretti Andrea , Nicastro Vincenzo , Opocher Enrico , Gozzo Davide , Casoni Pattacini Gianmaria , Castriconi Maurizio , Amendola Alfonso , Gaudiello Maria , Palomba Giuseppe , Catena Fausto , Petracca Gabriele L. , Perrone Gennaro , Giuffrida Mario , Moretto Gianluigi , Impellizzeri Harmony , Casaril Andrea , Filosa Mauro , Caizzone Antonio , Agrusti Sonia , Cattaneo Gaetano M. , Capelli Palomba , Muratore Andrea , Calabrò Marcello , Pipitore Federico Nicoletta S. , Cuzzola Bruno , Danna Riccardo , Murgese Alessandra , Coccolini Federico , Pieroni Erica , Chiarugi Massimo , Tartaglia Dario , Giannessi Sandro , Somigli Riccardo , Trafeli Martina , Fedi Massimo , De Vincenti Rosita , Guariniello Anna , Grande Michele , Bagaglini Giulia , Pirozzi Brunella , Guida Andrea M. , Ingallinella Sara , Don Cristine P. , Siragusa Leandro , Capone Orazio , Cerbo Daniele , Santoro Emanuele , Pende Vito , Fassari Alessia , Mingoli Andrea , Brachini Gioia , Cirillo Bruno , Zambon Martina , Cicerchia Pierfranco , Meneghini Simona , Sapienza Paolo , Puzzovio Antonella , La Torre Filippo , Fransvea Pietro , Di Grezia Marta , Sganga Gabriele , Armellino Mariano F. , Ioia Giovanna , Rampone Bernardino , Della Corte Marcello , Fleres Francesco , Clarizia Guglielmo , Bordoni Pierpaolo , Spolini Alessandro , Franzini Marco , Grechi Alessandro , Suppo Monica , Bono Dario , Scaglione Donatella , Cotsoglou Christian , Paleini Sissi , Chierici Andrea P. , Uccelli Matteo , Olmi Stefano , Cesana Giovanni , Tenreiro Nadia , Marcal Andre , Martins Daniela , Leal Clara , Vieira Bruno , Ugarte-Sierra Bakarne , Vincene-Rodriguez Irune , Duran-Ballesteros Marta , Sanz-Larrainzar Amaia , Ibanez-Aguirre Francisco J. , Yanez-Benites Carlos , Talal Issa , Blas Juan L. , Garau Roberta , Clark-Stuart Saskia , Wallace Angus , Di Carlo Andrew , Wisnia Ellen , Ehsan Konain , Beck-Sanders Kellen , Godson Emma , Campbell Paul , Tebala Giovanni D. , Bignell Mark , Bond-Smith Giles , Lewis Christopher , Ahmad Raheel , Ali Roshneen , Aswani Sambasivan S. , Barza Afzal , Carrillo Catalina , Dawani Aruna , Dey Abishek , Elserafy Amr , Gaspar Diana , Lazzareschi Lucia , Patel Mitul , Shabana Amanda , Shams Mohamed , Shams Ola , Slack Zoe 
Published: January 2022

Abstract
Introduction
The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic.

Materials and methods
Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods.

Results
Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase.

Conclusions
Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.