Mitigating surgical emergency practice during COVID-19 pandemic?

Zafar, Noman; Kashora, Florence; Qurashi, Kamran; Al-Musawi, Jasim; Watfah, Josef; Liasis, Lampros; Sen, Manoj; Gould, Stuart; J Vaizey, Carolynne; Warusavitarne, Janindra; Leo, Cosimo Alex

PURPOSE To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic. METHODS Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload for the same time period prior to lockdown. RESULTS Surgical emergencies admissions reduced by 2.5 times during our study period (p value = 0.001). In this changed paradigm, the overall number of surgical emergencies were reduced. A high mortality (n = 4, 5.7%) was noted during lockdown period as compared to pre-lockdown period (n = 1, 0.58%, p value = 0.025). Almost half of surgical admissions were tested for COVID-19 based on their symptoms and more than third (n=14, 38.9%) of them were positive. Gastrointestinal symptoms were common in COVID-19 positive group (85.7%) and only a third (36%) of COVID-19 positive patients needed surgical attention. Chest x-ray findings were comparable to PCR testing in terms of sensitivity and specificity but CT chest was more sensitive. CONCLUSIONS It remains unclear how COVID-19 reduced surgical emergencies. A significant proportion of COVID-19 presented with gastrointestinal symptoms. In a new outbreak all General Surgical patients should be tested with CRP and WCC used as a triage adjunct. KEY WORDS Coronavirus, COVID-19, Emergency Surgery Pandemic, General Surgery.