ABSTRACT
Background The coronavirus pandemic has caused global disruption to all aspects of life. This disturbance has been most notable in the medical world. Political, societal, medical, and behavioral alterations have forced emergency surgical practices to adapt. This study investigated the impact of coronavirus 2019 (COVID-19) at a busy surgical center. Methodology This is a retrospective observational study. Three study periods were analyzed: pre-COVID, first wave, and second wave. Data were collected on referrals, diagnoses, investigations, management pathways, outcomes, patient behavior, and consultant practice. A one-way analysis of variance (ANOVA test) was used for the analysis of parametric data and the Mann-Whitney U test for non-parametric data. Results Declining numbers of patients presented across the three periods. There was a severe disruption in performing emergency general surgeries during the first wave, propagated by alterations in clinical decision-making, as well as fluctuations in societal and patient behavior. Despite the effects of the second wave being significantly more profound in terms of hospitalization and COVID-related mortality, a paradoxical, gradual return to the norm was noted, which was seen in referral pathways, imaging decisions, and management strategies. Conclusion Our data is suggestive of society, both within and outside the medical sphere, adjusting to life with COVID-19.
ABSTRACT
Abstract This study investigated the impact of COVID-19 on emergency general surgery practice particularly on referrals, diagnosis, investigations, management pathways, outcomes, patient behaviour and consultant practice. Retrospective data collection from two cohorts: 112 patients admitted over one week in pre-COVID period and 90 patients admitted over one week during the COVID period. A patient questionnaire and a consultant questionnaire were used to collect data on patient behaviour and consultant practice. The COVID period saw an almost four times and seven times increase in performed X-rays (CXRs) and CT-thorax-abdomen-pelvis (TAPs), respectively;6.5% increase in conservative and 6.2% reduction in surgical management;approximately 50% decline in length of stay (LoS) in conservatively managed patients;71% of patients' decisions to attend hospital were unaffected;and 78.6% of consultant surgeons peferred to manage patients conservatively. Overall, there were delayed hospital presentations by patients by almost twice as long, increase in paediatric referrals, a surge in performed scans, and a reduction in hospital stay in patients managed conservatively. Patient behaviour to attend hospital was not heavily influenced by COVID, but consultant practice certainly changed towards more conservative choices. Future studies should explore the impact on paediatric referrals and long-term effects on surgical training.