The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase. Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

中文翻译：

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急诊手术入院和 COVID-19 大流行：第一波真的改变了我们的做法吗？ACOI/WSES 国际回顾性队列审计对 6263 名患者的结果

COVID-19 大流行对急诊外科服务产生了深远的影响，全球范围内进入急诊外科病房的患者显着减少。这种减少的可靠数字尚未产生。我们的国际审计旨在准确了解大流行爆发时急诊外科入院的绝对和相对变化。收集了在 2020 年 3 月和 4 月（Covid-19 大流行爆发）期间进入 45 个国际分布的急诊外科病房的普通外科急诊患者的数据集，并与 3 月和 4 月入住同一病房的患者的数据集进行了比较2019 年（Covid-19 之前）。主要终点是评估两个研究期间表现症状和出院诊断的相对变化。次要终点是确定在相同的两个时期内治疗策略可能发生的变化。参与的 45 个中心将他们的匿名数据发送到研究中心，共有 6263 名患者。其中，3810 人在 Covid 之前的时期被录取，2453 人在 Covid 时期被录取，绝对减少了 35.6%。最常见的表现是腹痛，其发病率在两个时期之间没有变化，但在 Covid 时期，患者出现肛门疼痛、疝气、贫血和体重减轻的频率较低。ASA 1 和低体弱患者入院频率较低，而 ASA>1 和体弱患者相对增加。手术入路的类型没有显着变化，但两个研究期间的膝上开放转换率减半。阑尾炎和憩室炎的出院诊断显着减少，而肠缺血和肛周疾病的相对增加显着。我们的审计表明，在 Covid-19 大流行爆发时，急诊手术入院人数总体显着减少，而单次就诊、诊断和治疗的比例变化很小。这些发现可能会为管理外科紧急情况的新方法打开大门，而不会吞噬已经繁忙的医院。而肠缺血和肛周疾病有显着的相对增加。我们的审计表明，在 Covid-19 大流行爆发时，急诊手术入院人数总体显着减少，而单次就诊、诊断和治疗的比例变化很小。这些发现可能会为管理外科紧急情况的新方法打开大门，而不会吞噬已经繁忙的医院。而肠缺血和肛周疾病有显着的相对增加。我们的审计表明，在 Covid-19 大流行爆发时，急诊手术入院人数总体显着减少，而单次就诊、诊断和治疗的比例变化很小。这些发现可能会为管理外科紧急情况的新方法打开大门，而不会吞噬已经繁忙的医院。