TP10.1.1Unveiled by Covid-19: The True Rate of Emergency General Surgery

Abstract

AimsThe Covid-19 pandemic has impacted every NHS service, including the provision of elective and emergency surgery. National lockdown, travel restrictions and intercollegiate guidance on conservative management of acute surgical conditions were introduced in an effort to reduce the burden on emergency services. This service evaluation aimed to evaluate the impact of the Covid-19 pandemic on emergency general surgical presentations and operations, and to determine whether the rate of surgical intervention changed.MethodsPatients presenting to the surgical emergency unit in a large tertiary centre were identified through electronic admission records between March to April 2019 and the same period in 2020. Data on presentation, admission and operations were collected and compared between the two periods.ResultsPresentations in 2020 reduced by 38% from 1324 to 823. Operations performed decreased by 44% from 334 to 188. The proportion of presentations requiring emergency operations was 23% in 2020 compared to 25% in 2019. Emergency laparotomies increased from 30 to 40, constituting a greater proportion of operations (9% vs. 21%). Rates of appendicectomies remained the same at 26% vs. 27%. Urgent procedures including cholecystectomies, hernia repairs and abscess drainage decreased from 55% to 42% of all cases.ConclusionsThere was an absolute reduction in emergency presentations and operations between the two periods. This reduction could be accounted for by decreased presentations of patients with non-surgical abdominal pain due to lockdown. However, more critically unwell patients presented indicated by the increased number of laparotomies demonstrating the ongoing need for emergency surgery.