Impact of Covid on emergency laparotomy activity

ABSTRACT

Aims: National surgical guidance during The Covid-19 pandemic cautioned against surgical intervention with subsequent unsurprising falls in emergency activity. Our unit, in contrast to national guidance, treated patients normally but with enhanced quality measures and without withholding surgery where indicated;key measures introduced included two-consultant operating, early consultant decision-making and daily consultant ward rounds to facilitate early discharge. This study outcomes from these locally developed guidelines. Method(s) All emergency laparotomies are entered contemporaneously On to The NELA database. Activity and outcomes from two time periods, from before and after The advent of Covid-19 (March 2019-2020 vs. March 2020-2021) were compared. Result(s) Emergency laparotomy activity increased from 154 cases to 192 cases (24%). There were no pre-operative differences in frailty scores, ASA, pre-operative predicted mortality (7.4% vs. 6.9%) or predicted morbidity between The two periods. Although 2% of patients developed Covid-19 infection, there was no increase in crude mortality (9% to 8%) or post-operative complications. The proportion of patients who went to critical care after surgery fell though post-operative length of stay also fell (mean 18.8 days vs. 12 days). Conclusion(s) With local guidelines and enhanced consultant-delivered care, emergency surgery was increased during The Covid pandemic without increased complications. This may reflect The marked reduction in activity in neighbouring hospitals and additional capacity due to falls in elective activity. Given The reduction in emergency surgery nationally, it is likely that guidance which cautioned against surgery has led to patients unnecessarily missing out On operative treatment with subsequent poorer outcomes and greater mortality.