COVID-19 and Digestive Surgical Emergencies: Experience of the General Surgery Department of Tangier University Hospital.

On March 11, 2020, the WHO declared that the epidemic of COVID-19 had become a pandemic, and this disrupted all the regulated operative programs. On the other hand and by its urgent nature, the emergency surgery was maintained with particularity in some situations, an association with infection by COVID-19. The circumstances of diagnosis of the association of infection by COVID-19 and surgical emergency are based on clinical, radiological, and biological criteria. In this work we report the experience of the University Hospital of Tangier concerning the management of three patients with the particularity of associating a covid infection and a digestive surgical emergency, we will discuss through these cases, the necessary protective measures in intraoperative and the impact of the covid infection on the morbi-mortality Concerning the impact of covid infection on postoperative morbidity and mortality, there are generally two situations: When the covid infection is benign, the prognosis depends on the severity of the surgical emergency and in this situation the prognosis is the same as for patients not infected by covid, this is the case of the first and third cases. The second situation; when the covid infection is severe, it has a great impact on the prognosis and the postoperative care in intensive care. With this publication, we are trying to provide information to help surgeons better manage this category of patients, especially in view of the panic caused by the pandemic, and the difficulty of adapting to the new patient circuit, but more studies recruiting more cases are needed to confirm our findings.

Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

IntroductionThe 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. Materials and methodsDatasets 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. ResultsForty-four 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.ConclusionsOur 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.

Cardiovascular Surgical Emergencies in France, before, during and after the First Lockdown for COVID-19 in 2020: A Comparative Nationwide Retrospective Cohort Study

Background: There are still gaps regarding the impact of the nationwide lockdown on non-COVID-19 emergency hospitalizations. This study aims to describe the trends in hospitalizations for cardiovascular surgical emergencies in France, before, during and after the first lockdown. Materials and Methods: All adults admitted for mechanical complications of myocardial infarction (MI), aortic dissection, aortic aneurysm rupture, acute and critical limb ischemia, circulatory assistance, heart transplantation and major amputation were included. This retrospective cohort study used the French National Hospital Discharge database. The numbers of hospitalizations per month in 2020 were compared to the previous three years. Results: From January to September 2020, 94,408 cases of the studied conditions were reported versus 103,126 in the same period in 2019 (-8.5%). There was a deep drop in most conditions during the lockdown, except for circulatory assistance, which increased. After the lockdown, mechanical complications of MI and aortic aneurysm rupture increased, and cardiac transplantations declined compared with previous years. Conclusion: We confirmed a deep drop in most cardiovascular surgical emergencies during the lockdown. The post-lockdown period was characterized by a small over-recovery for mechanical complications of MI and aortic aneurysm rupture, suggesting that many patients were able to access surgery after the lockdown.

EP.TU.373What We Do In The Shadows: Night Surgical Registrars and Abdominal Pain

Aim Surgical cover at night differ according to hospitals and are often performed by junior registrars. This can be challenging as a certain amount of independence is required in decision making. Abdominal pain remains one of the most common surgical presentations in the Emergency Department. This study analyses the type of abdominal pain presentations that were reviewed overnight in a regional Australian hospital. Method All patient presentations requiring surgical review from 9.00pm to 7.00am over a period of 4 months are prospectively collected and analysed. Patient details collected comprised of gender, date of review, blood tests, imaging results, histopathology, and intra-operative findings. Results Of the 114 patients who presented with abdominal pain, the majority of them were undifferentiated abdominal pain (n = 20, 17.1%). This is then followed by appendicitis (n = 17, 14.5%), diverticulitis (n = 13, 11.1%), pancreatitis (n = 8, 6.8%) and cholecystitis (n = 6, 5.1%). Among the others, a total of 8 presentations required urgent surgical review which resulted in three emergency surgeries being performed overnight, a laparotomy for closed loop small bowel obstruction, a Hartmann's procedure and a laparoscopic appendicectomy on a septic patient. Conclusion Common presentations for abdominal pain overnight include undifferentiated abdominal pain, appendicitis, diverticulitis, cholecystitis and pancreatitis. Hence education for night surgical registrars should be focused on management of these common conditions and also on surgical emergencies such as closed loop bowel obstructions, septic patients and perforated viscus to ensure optimal patient outcome without the need for close supervision.

SP4.2.11 Access to emergency theatre during the COVID -19 pandemic

Aims To investigate the impact of the COVID-19 pandemic on general surgical emergencies and access to theatre during the pandemic. Methods We retrospectively reviewed emergency theatre lists in three distinct time periods: October 2019 (pre-COVID-19 era), April 2020 (first peak) and October 2020 (regional second peak). We extracted and compared data from a prospectively maintained database to calculate patient waiting times. Statistical analysis was performed with SPSS software v21.0 to compare median waiting times between groups and significance was set to a p value of < 0.05. Results Conclusions Despite the initial major drop in general surgical procedures and waiting times, the decreased availability of theatre lists due to staff redeployment and sickness, the introduction of routine pre-operative COVID-19 testing have all resulted in a significant increase in waiting time for urgent (CEPOD 2A) cases during the second peak.

TP9.2.7Acute Surgical Admissions at the End of Life: an Analysis of Deaths in Non-operatively Managed Patients

Aims Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. Methods This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. Results 72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. Conclusion Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.