Repercussions of covid-19-related national lockdown on emergency surgery department: a longitudinal cohort monocentric study

Background: COVID-19 lockdown restrictions in conjunction with the pervasive hospital fear endured by the vast majority of the population played a fundamental role in discouraging access to emergency departments (EDs). We aimed at investigating whether and how the COVID-19 outbreak limited access to ED and affected urgent surgical activities during and immediately after the 2-month pandemic-related national lockdown. Methods: Data regarding patients who accessed to the surgical ED were retrospectively collected. Analysed time-periods included: 'Pre-COVID-19 Era', 'COVID-19 Era' considered as the period of full national lockdown and 'Post-COVID-19 Era' after easing of lockdown measures. Consecutive emergency surgical procedures and ED admissions before, during and after COVID-19-lockdown were retrieved and analysed. Results: There was a significant decrease in overall ED admissions and in all-specialty surgical consultations (P<0.01) throughout the outbreak. Once national lockdown was eased, we recorded a subsequent rebound 5-fold rise of emergency surgical procedures compared to COVID-19 group (P=0.011). Time-to-surgery was significantly greater in 'COVID-19 era' and 'post-COVID-19 era' compared to 'pre-COVID-19' group (22.56±4.78, 75.99±15.89 and 16.73 ±1.76 hours, respectively) (P<0.01). A raised incidence of postoperative complications emerged in the 'COVID-19 era' group (37.5%) compared to pre and post-COVID groups (9.1% and 12.5%, respectively; P<0.001). Mortality rate in the 'COVID-19 era' was 31.3% and 7.5% in 'post-COVID-19' group (<0.0001). Conclusions: This study demonstrates the major reduction of emergency surgical procedures and overall ED admissions caused by COVID-19 pandemic. The raised rate of postoperative complications and mortality might be likely due to the superior severity of surgical conditions observed in the 'COVID-19 era' subjects together with a probable deferred pursuit of medical attention.