Impact of COVID-19 on Surgical Cases Referred from the Emergency Department in a Tertiary County Hospital in the US

ABSTRACT

Study Objectives: The onset of the COVID-19 pandemic has caused lower emergency department (ED) volume in the US and globally with many cities experiencing fewer patients seeking health care at hospitals. Initial low ED volumes were attributed to stay-at-home orders because of fear of contracting severe respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this study is to assess whether these changes have affected the surgical burden at an urban tertiary county hospital emergency department. Several operating rooms (OR) were converted to COVID units to accommodate the increased COVID patient volume. Characterizing the surgical burden during the COVID pandemic will allow health care clinicians and hospitals to understand how to effectively utilize limited resources. Methods: This is a retrospective review of patients who presented to a large county hospital emergency department and needed surgical intervention from December 10, 2019 until August 1, 2020. The patients were divided into 4 phases and were compared to control data from the previous year. Trauma cases were excluded. The following variables were used to assess for significant differences between the phases weekly surgical volume, surgical type, and time to operating room. Chi-squared analysis was primarily utilized to compare data between phases. Results: A total of 3636 study participants were included, with an additional 4765 patients from the control phase. During the COVID phase in 2020, surgical volume decreased as much as 48% in April as compared with the control phase in 2019 (Figure 1). Patients needing surgical intervention during the COVID phase had fewer comorbidities than those who presented in the pre-COVID phase. Across the 4 phases, this population had increasing percentages of OB/GYN cases (6.2%, 6.3%, 7.2%, 7.4% for Phases 1, 2, 3, 4 respectively. Notably, there was an overall decrease in laparoscopic cholecystectomy (14.2%, 14.1%, 12.3%, 9.9%) cases. Significant differences in orthopedic (p = 0.008), podiatry (p = 0.015), and burn (p = 0.0009) cases were found during the COVID phases as compared to the control phases. The time to OR was also significantly less during the COVID phases than in the pre-COVID (p < 0.05) and control (p = 0.0024) phases. Conclusion: There was a decrease in surgical volume during the COVID phase and improved time to OR. The increases in burns, podiatry, and orthopaedic cases during the pandemic may suggest an epidemiological change of injuries treated in the ED. Concerns have also been raised for domestic violence orthopedic-related injuries. Patients may have been less likely to seek care in the ED due to fear of contracting SARS-CoV-2. Anticipating the types of surgical cases and volume will help the hospital staff allocate resources more effectively for similar events in the future. [Formula presented]