Is There a Delay in Emergency Surgical Procedures in a Designated COVID-19 Hospital? -The Hospital Sungai Buloh (Malaysia) Experience

Abstract

Introduction: The global pandemic Corona Virus Disease 2019 (COVID-19) caused by Severe acute respiratory syndrome coronavirus 2 (SARS, CoV-2) is highly contagious and has driven many hospitals including Hospital Sungai Buloh (HSB) in Malaysia to become a designated hospital exclusively for COVID-19 patients only. These patients may develop complications requiring surgical consultation and intervention which have led to concerns regarding delay in the surgical management of these patients. Currently, there is a paucity of published data worldwide with regards to whether there is a delay in the time taken to perform the intended emergency procedure that has been planned by the attending surgical team. Method: This single-centered, retrospective study aims to investigate whether there is any delay in performing emergency surgical procedures during the COVID-19 pandemic in HSB from 1/3/2020 to 30/3/2021. All the cases were categorized based on recommended priority into acute emergency, emergency, and urgent. Results: There were a total of 105 patients; 5(4.8%) acute emergency cases, 22(21.0%) emergency cases, and 78 (74% cases) required an urgent intervention of which the majority had an endoscopic procedure performed i.e., 85.9% (67 cases) compared to surgery, 14.1% (11 cases). Patients in the emergency procedure category took the longest time to intervene whereby the median time taken was 548 minutes. 50% of patients in this category were delayed. Patients in the acute emergency category had delays seen in all 5 patients, with a median of 239 minutes. On the other hand, patients in the urgent category had only 10.3% of the patients who were delayed. Conclusion: From the total of 105 patients requiring emergency surgical intervention over 12 months period during the COVID-19 pandemic, the delay was seen in 24 patients (23% of cases). Multiple factors contributing to the delay have been postulated, pertaining to the implementation of the new Standard Operating Procedure (SOP) in managing COVID-19 patients in general, which needs to be verified with further study and addressed accordingly. KEYWORDS: Corona Virus Disease 2019, COVID-19 Pandemic, Emergency surgical intervention, Managing COVID-19 patients.