Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members
Authors: Reichert Martin , Sartelli Massimo , Weigand Markus A. , Hecker Matthias , Oppelt Philip U. , Noll Julia , Askevold Ingolf H. , Liese Juliane , Padberg Winfried , Coccolini Federico , Catena Fausto , Hecker Andreas ,   The WSES COVID-19 emergency surgery survey collaboration group, Peckham-Cooper Adam , Camacho-Ortiz Adrian , Mastoraki Aikaterini T. , Landaluce-Olavarria Aitor , Pal Ajay Kumar , Kuriyama Akira , Chichom-Mefire Alain , Porcu Alberto , Martínez-Pérez Aleix , Karamarkovic Aleksandar R. , Osipov Aleksei V. , Coppola Alessandro , Cucchetti Alessandro , Spolini Alessandro , Giordano Alessio , Reinisch-Liese Alexander , Kavalakat Alfie J. , Vasilescu Alin , Alamin Amin , Gupta Amit , Dascalu Ana Maria , Musina Ana-Maria , Bakopoulos Anargyros , Zakaria Andee Dzulkarnaen , Vereczkei Andras , Balla Andrea , Bottari Andrea , Baumann Andreas , Fette Andreas , Litvin Andrey , Reichert Aniella Katharina , Guariniello Anna , Paspala Anna , Schneck Anne-Sophie , Brillantino Antonio , Pesce Antonio , Isik Arda , Leppäniemi Ari Kalevi , Papadopoulos Aristeidis , Kechagias Aristotelis , Mohamed Ashraf Yehya Abdalla , Mitul Ashrarur Rahman , Marinis Athanasios , Syllaios Athanasios , Mantoglu Baris , De Simone Belinda , Weiss Benjamin Stefan , Pösentrup Bernd , Picardi Biagio , Zampogna Biagio , Sakakushev Boris Eugeniev , Atanasov Boyko Chavdarov , Nardo Bruno , Calik Bulent , Cremonini Camilla , Ordoñez Carlos A. , Seretis Charalampos , Cascone Chiara , Chouliaras Christos , Bendinelli Cino , Lopes Claudia , Guerci Claudio , Weber Clemens , Nastos Constantinos , Mesina Cristian , Caputo Damiano , Massalou Damien , Cavaliere Davide , McNamara Deborah A. , Demetriades Demetrios , Pantalone Desirè , Coletta Diego , Sasia Diego , Visconti Diego , Weber Dieter G. , Corallino Diletta , Chatzipetris Dimitrios , Manatakis Dimitrios K. , Ntourakis Dimitrios , Papaconstantinou Dimitrios , Schizas Dimitrios , Chrysikos Dimosthenis , Adamovich Dmitry Mikhailovich , Elkafrawy Doaa , Serban Dragos , García Edgar Fernando Hernandez , Baldini Edoardo , Picetti Edoardo , Tan Edward C. T. H. , Baili Efstratia , Lostoridis Eftychios , Toma Elena Adelina , Colak Elif , Cerutti Elisabetta , Steyn Elmin , Hsabo Elmuiz A. , Kapetanakis Emmanouil Ioannis , Kaouras Emmanouil , Schneck Emmanuel , Akin Emrah , Gonullu Emre , çelik Enes , Cicuttin Enrico , Pinotti Enrico , Johnsson Erik , Moore Ernest E. , Agastra Ervis , Dimitrov Evgeni Nikolaev , Griffiths Ewen A. , D’Acapito Fabrizio , Saraceno Federica , Alconchel Felipe , Zeppernick Felix Alexander , Rodríguez Fernando Machado , Abu-Zidan Fikri , Pecchini Francesca , Favi Francesco , Ferrara Francesco , Fleres Francesco , Pata Francesco , Roscio Francesco Pietro Maria , Mulita Francesk , Dor Frank J. M. F. , Linder Fredrik , Dimofte Gabriel , Rodrigues Gabriel , Nita Gabriela , Sganga Gabriele , Martines Gennaro , Mazzarella Gennaro , Perrone Gennaro , Velmahos George , Lianos Georgios D. , Tomadze Gia , Baiocchi Gian Luca , D’Ambrosio Giancarlo , Pellino Gianluca , Pattacini Gianmaria Casoni , Giraudo Giorgio , Lisi Giorgio , Tebala Giovanni Domenico , Pirozzolo Giovanni , Montori Giulia , Argenio Giulio , Brisinda Giuseppe , Currò Giuseppe , Giuliani Giuseppe , Palomba Giuseppe , Roscitano Giuseppe , Avşar Gökhan , Augustin Goran , Clarizia Guglielmo , Vega Gustavo M. Machain , Fraga Gustavo P. , Sethi Harsheet , Eltyeb Hazim Abdulnassir , Lohse Helmut A. Segovia , Lohse Herald René Segovia , Bayhan Hüseyin , Hamid Hytham K. S. , Kryvoruchko Igor A. , Iannone Immacolata , Wani Imtiaz , Lazaridis Ioannis I. , Katsaros Ioannis , Nikolopoulos Ioannis , Negoi Ionut , Reccia Isabella , Di Carlo Isidoro , Olaoye Iyiade Olatunde , Czepiel Jacek , Kim Jae Il , Meyer Jeremy , Terrazas Jesus Manuel Saenz , Tochie Joel Noutakdie , Galante Joseph M. , Davies Justin , Sugand Kapil , Gonfa Kebebe Bekele , Rasa Kemal , Kok Kenneth Y. Y. , Apostolou Konstantinos G. , Lasithiotakis Konstantinos , Tsekouras Konstantinos , Angamuthu Kumar , Akhmeteli Lali , Sydorchuk Larysa , Fortuna Laura , Siragusa Leandro , Pagani Leonardo , Solaini Leonardo , Miller Lisa A. , Bains Lovenish , Ansaloni Luca , Ferrario Luca , Bonavina Luigi , Conti Luigi , Buonomo Luis Antonio , Tallon-Aguilar Luis , Tomczyk Lukas , Widmer Lukas Werner , Walędziak Maciej , Gachabayov Mahir , Bulanauca Maloni M. , Malbrain Manu L. N. G. , Maegele Marc , Catarci Marco , Ceresoli Marco , Ranucci Maria Chiara , Antonopoulou Maria Ioanna , Papadoliopoulou Maria , Valenti Maria Rosaria , Sotiropoulou Maria , D’Oria Mario , Martín Mario Serradilla , Hirschburger Markus , Veroux Massimiliano , Fantoni Massimo , Nardi Matteo , Tolonen Matti , Montuori Mauro , Podda Mauro , Scheiterle Maximilian , Frountzas Maximos , Sarıkaya Mehmet , Yildirim Mehmet , Bender Michael , Vailas Michail , Teuben Michel , Campanelli Michela , Ammendola Michele , Malerba Michele , Pisano Michele , Pertea Mihaela , Slavchev Mihail , Ukkonen Mika , Bala Miklosh , Chirica Mircea , Barone Mirko , Shaat Mohamed Maher , Mohammed Mohammed Jibreel Suliman , Abuelgasim Mona Awad Akasha , Gureh Monika , Ouadii Mouaqit , Balkan Mujdat , Mohamed Mumin , Hakseven Musluh , Velenciuc Natalia , Cillara Nicola , de’Angelis Nicola , Tamini Nicolò , Zavras Nikolaos J. , Machairas Nikolaos , Michalopoulos Nikolaos , Koliakos Nikolaos N. , Pararas Nikolaos , Donlon Noel E. , Medappil Noushif , Ben-Ishay Offir , Stefano Olmi , Islam Omar , Tammo Ömer , Ioannidis Orestis , Aparicio Oscar , Baraket Oussama , Kumar Pankaj , Cianci Pasquale , Örtenwall Per , Uchikov Petar Angelov , de Reuver Philip , Stahel Philip F. , Barie Philip S. , Piccoli Micaela , Major Piotr , Navsaria Pradeep H. , Sasmal Prakash Kumar , Coimbra Raul , Rahim Razrim , Çapoğlu Recayi , Koshy Renol M. , Gonsaga Ricardo Alessandro Teixeira , Pertile Riccardo , Mohamed Rifat Ramadan Mussa , Deryol Rıza , Sawyer Robert G. , Angelico Roberta , Ragozzino Roberta , Bini Roberto , Cammarata Roberto , Scaramuzzo Rosa , Gioco Rossella , Sydorchuk Ruslan , Ahmed Salma , Di Saverio Salomone , Emile Sameh Hany , Delibegovic Samir , Marwah Sanjay , Symeonidis Savvas , Thomas Scott G. , Demir Sebahattin , Awad Selmy S. , Atici Semra Demirli , Chooklin Serge , Meric Serhat , Sarıkaya Sevcan , Chowdhury Sharfuddin , Mirghani Shaza Faycal , Wren Sherry M. , Gargarella Simone , Del Monte Simone Rossi , Esposito Sofia , Xenaki Sofia , Mohamed Soliman Fayez Ghedan , Beka Solomon Gurmu , Lunca Sorinel , Delis Spiros G. , Dritsas Spyridon , Morarasu Stefan , Magnone Stefano , Rossi Stefano , Bitsianis Stefanos , Kykalos Stylianos , Baral Suman , Jain Sumita A. , Ali Syed Muhammad , Pintar Tadeja , Triantafyllou Tania , Delko Tarik , Perra Teresa , Sidiropoulos Theodoros A. , Scalea Thomas M. , Vilz Tim Oliver , Hardcastle Timothy Craig , Wannatoop Tongporn , Herzog Torsten , Mishra Tushar Subhadarshan , Boggi Ugo , Calu Valentin , Tomajer Valentina , Agnoletti Vanni , Lohsiriwat Varut , Kong Victor , Muñoz-Cruzado Virginia Durán , Shelat Vishal G. , Khokha Vladimir , Ghannam Wagih Mommtaz , Biffl Walter L. , Zuidema Wietse , Kara Yasin , Kobe Yoshiro , Demetrashvili Zaza , Memish Ziad A. , Madrazo Zoilo , Balogh Zsolt J. , Bayhan Zulfu 
Published: June 2022

Abstract
Background
The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic.

Methods
A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine.

Results
367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis.

Conclusions
The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years.