Urgent/emergency surgery during COVID-19 state of emergency in Portugal: a retrospective and observational study
Cirurgia de urgência/emergência durante o estado de emergência COVID-19 em Portugal: estudo retrospectivo e observacional
Andreia Filipa Sá, Sofia Fonseca Lourenço, Rafael da Silva Teixeira, Filinto Barros, António Costa, Paulo Lemos
Abstract
Background
SARS-CoV-2 virus changed society’s behaviour. Population was advised to reduce unnecessary heath care use to accommodate urgent cases and daily increase of COVID-19 patients. Health care facilities faced huge challenges, having to readjust their response to preserve good quality of care. In Portugal, a significant reduction in the number of admissions to the Emergency Department (ED) was reported all over the country, however the impact on the dynamics of undeferrable surgery remains to be reported. This study compares the volume and characteristics of urgent/emergency surgery in 2020 COVID-19 pandemic with the homologous period in 2019, chronologically illustrating the national evolution of new COVID-19 cases and the social and hospital containment response.
Methods
A retrospective observational study was conducted in a tertiary hospital center located in the most affected region by COVID-19 in Portugal. Medical records of patients who underwent urgent/emergency surgery between March 1st and May 2nd of both 2020 and 2019 were examined and the volume of surgeries were compared. Also, daily national updates from Portuguese Directorate-General for Health were analysed.
Results
During the COVID-19 pandemic approximately 30% less patients underwent urgent/emergency surgery (99%CI = 0.18–0.61, p < 0.001). Waiting time for surgery showed no difference between both years (p = 0.068), but patients who did surgery during the 2020 pandemic had higher mortality rates than the ones who did it in 2019 (11.4% in 2020 and 5.9% in 2019, p = 0.001). Reduction in surgery volume was correlated with the increasing number of infected cases nationally.
Conclusion
This study demonstrates decreasing numbers of urgent/emergency procedures during the COVID-19 pandemic that may be justified by the national growth number of infected cases. Preoperative mass screening strategy was implemented without compromising the efficiency of surgical service, but patients’ mortality was higher. The importance of visiting the ED during COVID-19 pandemic for serious cases that cannot be managed in other settings should be highlighted.
Keywords
References
1 N. Zhu, D. Zhang, W. Wang, et al. A novel coronavirus from patients with pneumonia in China, 2019 N Engl J Med, 382 (2020), pp. 727-733
2 ECDC. Risk assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, China: first local transmission in the EU/EEA − third update. https://www.ecdc.europa.eu/en/publications-data/risk-assessment-outbreak-acute-respiratory-syndrome-associated-novel-1. Published 2020. Accessed May 9, 2020.
3 DGS. RELATÓRIO DE SITUAÇÃO-1.; 2020. https://covid19.min-saude.pt/ponto-de-situacao-atual-em-portugal/. Accessed May 9, 2020.
4 Decreto do Presidente da República 14-A/2020, 2020-03-18 - DRE. Diário da República n.o 55/2020, 3o Suplemento, Série I. https://dre.pt/web/guest/home/-/dre/130399862/details/maximized. Published 18 March 2020. Accessed May 9, 2020.
5 O. Cano-Valderrama, X. Morales, C.J. Ferrigni, et al. Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study Int J Surg, 80 (2020), pp. 157-161
6 L. Dick, J. Green, J. Brown, et al. Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study World J Surg, 44 (2020), pp. 3590-3594
7 F. D’Urbano, N. Fabbri, M.K. Radica, E. Rossin, P. Carcoforo Emergency surgery in COVID-19 outbreak: Has anything changed? Single center experience World J Clin Cases, 8 (2020), pp. 3691-3696
8 R. Santana, J. Rocha, J. Sousa, et al. A Procura de Serviços de Urgência/ Emergência Hospitalar: Tendências Durante o Primeiro Mês de Resposta à COVID-19 https://www.ensp.unl.pt/wp-content/uploads/2017/06/tendencia-de-resposta-dos-servicos-de-urg-emerg-covid-19.pdf (2020)
9 Campos A. Procura das urgências caiu 45%. Onde estão os enfartes e os AVC, perguntam os investigadores | Covid-19 | PÚBLICO. https://www.publico.pt/2020/04/03/sociedade/noticia/procura-urgencias-caiu-45-onde-estao-enfartes-avc-perguntam-investigadores-1910910. Published 3 April 2020. Accessed May 9, 2020.
10 Pereira JC. Serviço de Urgência Hospitalar: lições da pandemia covid-19 | Opinião | PÚBLICO. https://www.publico.pt/2020/04/30/opiniao/opiniao/servico-urgencia-hospitalar-licoes-pandemia-covid19-1914446. Published 30 April 2020. Accessed May 9, 2020.
11 RELATÓRIO & CONTAS 2018 : Centro Hospitalar Universitário do Porto. https://www.chporto.pt/pdf/princ_bom_gov/chp_RC_2018Final.pdf. Published 2018. Accessed May 10, 2020.
12 P.J. Nogueirai, M. De Araújo Nobre, P.J. Nicola, et al. Excess mortality estimation during the COVID-19 pandemic: Preliminary data from Portugal Acta Med Port, 33 (2020), pp. 376-383
13 https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed May 9, 2020.
14 https://covid19.min-saude.pt/relatorio-de-situacao/. Accessed May 9, 2020.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email