Abstract
The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.
Highlights
In Italy, the earliest appearance of COVID-19 was confirmed on the 30 January 2020 [1].Thereafter, an outbreak of infections started in Lombardy, an Italian Northern Region, and extended progressively to the whole national territory [2]
Between 1 March and 31 December 2020, 648 patients were admitted to our emergency department (ED) due to the three analyzed causes of acute abdomen compared to 996 mean accesses during the same months of the three previous years
Considering the three conditions separately, a more pronounced decrease was registered for diverticulitis (135 vs. 262, −48.5%) and cholecystitis
Summary
In Italy, the earliest appearance of COVID-19 was confirmed on the 30 January 2020 [1].Thereafter, an outbreak of infections started in Lombardy, an Italian Northern Region, and extended progressively to the whole national territory [2]. Our institution, the main regional healthcare hub, rapidly admitted an increasing number of COVID-19 patients, reaching the total count of 2486 COVID-19 patients managed up to. The COVID-19 pandemic plunged the Italian health system into an extraordinary state of emergency, with many hospitals being dedicated exclusively to COVID-19 patients’ assistance, while other institutions, including our tertiary-level hospital, were forced to rapidly 4.0/). Change their workflow to admit both positive and negative patients through a fast and massive reorganization of wards and services. This reorganization reshaped emergency care, as well as patients’ behaviors and attitudes towards healthcare services.
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