The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

中文翻译：

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由于延迟访问，COVID-19 和国家封锁对急诊手术发病率的负面影响

这项回顾性比较研究的目的是通过比较 2019 年 3 月至 5 月期间（第 1 组）与全国同期的主要临床结果，评估 COVID-19 和延迟进入急诊科对急诊手术结果的影响。意大利的 COVID-19 封锁（2020 年 3 月至 5 月，第 2 组）。在患者的人口统计学、病史、手术、临床和管理特征之间进行了比较（第 1 组与第 2 组）和亚组分析。包括 246 名患者，第 1 组 137 名，第 2 组 109 名（p = 0.03）。两组的围手术期特征无显着差异。宣布延迟入院和术前 SARS-CoV-2 感染率在第 2 组中分别为 15.5% 和 5.8%。总体发病率（OR = 2.22，95% CI 1.08–4.55, p = 0.03) 和 30 天死亡率 (OR = 1.34, 95% CI 0.33–5.50, =0.68) 在第 2 组中显着更高。延迟进入队列显示出与发病率增加密切相关（ OR = 3.19, 95% CI 0.89–11.44, p = 0.07), 输血 (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) 和 30 天死亡风险 (OR = 8.00, 95% CI 1.0) 63.23，p = 0.05）。SARS-CoV-2 阳性患者的输血风险较高（20% 对 7.8%，p = 0.37）和入住 ICU 的风险较高（20% 对 2.6%，p = 0.17）和更长的中位 LOS（9 天对 4 天） , p = 0.11)。本文加深了对 COVID-19 大流行对患者获得急诊外科护理的影响的理解。我们的研究结果表明，COVID-19 改变了手术护理的质量，预后较差，发病率较高。