Effect of the COVID-19 Pandemic in Jerusalem on Acute Care Surgery
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Abstract
Background: Concerns were raised about the effect of the COVID-19 pandemic on patient morbidity because of delayed presentation to the hospital. This study aimed to assess the effect of the pandemic on the timing and severity of presentation to acute surgical care.
Methods: We retrospectively reviewed the medical charts of patients hospitalized in the General Surgery Department at Hadassah University Medical Center from March to August 2020. We evaluated patients diagnosed with four acute surgical diseases, including acute appendicitis (AA), acute diverticulitis (AD), acute cholecystitis (AC), and bowel obstruction (BO). For the control group, we reviewed similar cases from March to August 2019. We compared patient demographics, time intervals from arrival to the Emergency Department (ED) to diagnosis and operation if needed, surgical and in-hospital course, and severity of the diseases.
Results: The study included 376 patients, 242 in the control cohort and 134 in the COVID-19 cohort. The number of referrals and hospitalizations to the surgical department was significantly smaller in the COVID-19 cohort (p = 0.015). In the COVID-19 cohort, the time intervals for physicians' examination, imaging, and surgery were shorter (p = 0.010), but the time intervals for hospitalization were longer (p < 0.001). Also, the percentage of BO cases was higher (34.3% vs. 23.4%, p = 0.087), and the length of operations was longer (p = 0.058) in this cohort. No differences were found in the duration of symptoms, length of intensive care unit hospitalization, the severity of cases, or the course of hospitalization.
Conclusion: COVID-19 led to a significant decrease in referrals and urgent surgical hospitalizations during the pandemic without worsening of the patient condition. According to our study, some of the common surgical diseases may be managed conservatively without hospitalization.
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Copyright (c) 2025 Rabi O, et al.
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1. Aviran E, Laks S, Benvenisti H, Khalilieh S, Assaf D, Aviran N, et al. The impact of the COVID-19 pandemic on general surgery acute admissions and urgent operations: a comparative prospective study. Israel Medical Association Journal. 2020;22(11):673–679. Available from: https://pubmed.ncbi.nlm.nih.gov/33249785/
2. Franchini S, Spessot M, Landoni G, Piani C, Cappelletti C, Mariani F, et al. Stranger months: how SARS-CoV-2, fear of contagion, and lockdown measures impacted attendance and clinical activity during February and March 2020 at an urban emergency department in Milan. Disaster Medicine and Public Health Preparedness. 2021;15(5):e33–e42. Available from: https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/stranger-months/
3. Patriti A, Eugeni E, Guerra F. What happened to surgical emergencies in the era of the COVID-19 outbreak? Considerations of surgeons working in an Italian COVID-19 red zone. Updates in Surgery. 2020;72(2):309–310. Available from: https://link.springer.com/article/10.1007/s13304-020-00779-6
4. Hakes NA, Choi J, Spain DA, Forrester JD. Lessons from epidemics, pandemics, and surgery. Journal of the American College of Surgeons. 2020;231(6):770–776. Available from: https://www.sciencedirect.com/science/article/pii/S1072751520307461
5. Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J. Ebola and indirect effects on health service function in Sierra Leone. PLoS Currents. 2014;6. Available from: https://currents.plos.org/outbreaks/article/ebola-and-indirect-effects-on-health-service-function-in-sierra-leone/
6. Bundu I, Patel A, Mansaray A, Kamara TB, Hunt LM. Surgery in the time of Ebola: how events impacted a single surgical institution in Sierra Leone. Journal of the Royal Army Medical Corps. 2016;162(3):212–216. Available from: https://jramc.bmj.com/content/162/3/212
7. Ogundele IO, Alakaloko FM, Nwokoro CC, Ameh EA. Early impact of COVID-19 pandemic on paediatric surgical practice in Nigeria: a national survey of paediatric surgeons. BMJ Paediatrics Open. 2020;4(1):e000732. Available from: https://bmjpaedsopen.bmj.com/content/4/1/e000732
8. Cano-Valderrama O, Morales X, Ferrigni CJ, Martín-Antona E, Turrado V, García A, et al. Acute care surgery during the COVID-19 pandemic in Spain: changes in volume, causes, and complications. A multicentre retrospective cohort study. International Journal of Surgery. 2020;80:157–161. Available from: https://www.sciencedirect.com/science/article/pii/S1743919120303557
9. Tominaga GT, Staudenmayer KL, Shafi S, Schuster KM, Savage SA, Ross S, et al. The American Association for the Surgery of Trauma grading scale for 16 emergency general surgery conditions: disease-specific criteria characterizing anatomic severity grading. Journal of Trauma and Acute Care Surgery. 2016;81(3):593–602. Available from: https://journals.lww.com/jtrauma/Fulltext/2016/09000/
10. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Advances in Surgery. 1978;12:85–109. Available from: https://pubmed.ncbi.nlm.nih.gov/735943/
11. Callan R, Assaf N, Bevan K. Impact of the COVID-19 pandemic on acute general surgical admissions in a district general hospital in the United Kingdom: a retrospective cohort study. Surgery Research and Practice. 2020;2020:2975089. Available from: https://pubmed.ncbi.nlm.nih.gov/32832591/
12. Miklosh B. COVID-19 lockdown has no significant impact on trauma epidemiology and outcomes in a tertiary trauma center: retrospective cohort study. Surgeries. 2022;3(1):9. Available from: https://www.mdpi.com/2673-4095/3/1/9
13. Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. European Heart Journal – Quality of Care and Clinical Outcomes. 2021;7(1):18–27. Available from: https://academic.oup.com/ehjqcco/article/7/1/18/5977425
14. Patel R, Hainsworth AJ, Devlin K, Patel JH, Karim A. Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital. Annals of the Royal College of Surgeons of England. 2020;102(6):1–6. Available from: https://publishing.rcseng.ac.uk/doi/abs/10.1308/rcsann.2020.0147
15. Ciarleglio FA, Rigoni M, Mereu L, Tommaso C, Carrara A, Malossini G, et al. The negative effects of COVID-19 and the national lockdown on emergency surgery morbidity due to delayed access. World Journal of Emergency Surgery. 2021;16(1):37. Available from: https://wjes.biomedcentral.com/articles/10.1186/s13017-021-00382-z
16. Surek A, Ferahman S, Gemici E, Dural AC, Donmez T, Karabulut M. Effects of the COVID-19 pandemic on general surgical emergencies: are some emergencies really urgent? Level 1 trauma center experience. European Journal of Trauma and Emergency Surgery. 2021;47(3):647–652. Available from: https://link.springer.com/article/10.1007/s00068-020-01534-7
17. Tebala GD, Milani MS, Bignell M, Bond-Smith G, Lewis C, Cirocchi R, et al. Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients. World Journal of Emergency Surgery. 2022;17(1):8. Available from: https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00407-1
18. Alsaigh S, Harisi M, Almuhaymidi R, Al-Hojailan AA, Alharbi AZ, Alolayan SS, et al. Impacts of COVID-19 on patients with common surgical emergencies at the King Fahad Specialist Hospital in Buraidah, Saudi Arabia. Cureus. 2022;14(11):e31868. Available from: https://www.cureus.com/articles/108613
19. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Diseases of the Colon and Rectum. 2020;63(6):728–747. Available from: https://journals.lww.com/dcrjournal/Fulltext/2020/06000/
20. Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World Journal of Emergency Surgery. 2020;15(1):32. Available from: https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00313-4
21. Reinke CE, Wang H, Thompson K, Paton BL, Sherrill W, Ross SW, et al. Impact of COVID-19 on common non-elective general surgery diagnoses. Surgical Endoscopy. 2023;37(1):692–702. Available from: https://link.springer.com/article/10.1007/s00464-022-09154-5
22. Scheijmans JCG, Borgstein ABJ, Puylaert CAJ, Bom WJ, Bachiri S, van Bodegraven EA, et al. Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020. BMC Emergency Medicine. 2021;21(1):61. Available from: https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00454-y
23. Wang AW, Prieto J, Ikeda DS, Lewis PR, Benzer EM, Van Gent JM. Perforated appendicitis: an unintended consequence during the coronavirus disease 2019 pandemic. Military Medicine. 2021;186(1–2):e94–e97. Available from: https://pubmed.ncbi.nlm.nih.gov/33275655/
24. Kumaira Fonseca M, Trindade EN, Costa Filho OP, Nácul MP, Seabra AP. Impact of COVID-19 outbreak on the emergency presentation of acute appendicitis. American Surgeon. 2020;86(11):1508–1512. Available from: https://pubmed.ncbi.nlm.nih.gov/33156694/
25. Chrysos A, Amygdalos I, Nunes P, Haselow G, Lioupis K, Rosch R, et al. The impact of the COVID-19 outbreak on emergency general surgery in the first German hotspot region, Aachen–Heinsberg: a multicentre retrospective cohort study. PLoS One. 2023;18(1):e0280867. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0280867
26. McGuinness MJ, Harmston C. The effect of national public health interventions for COVID-19 on emergency general surgery in Northland, New Zealand. ANZ Journal of Surgery. 2021;91(3):329–334. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ans.16562
27. Celik SU, Lapsekili E, Alakus U. Impact of the COVID-19 pandemic on emergency general surgery outcomes: a single-center retrospective cohort study. Ulusal Travma ve Acil Cerrahi Dergisi. 2022;28(7):900–910. Available from: https://www.journalagent.com/travma/pdfs/UTD_28_7_900_910.pdf