Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England

Andrew Hutchings, Ramani Moonesinghe, Silvia Moler Zapata, David Alan Cromwell, Robert J Hinchliffe, Richard Grieve*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
25 Downloads (Pure)

Abstract

Background
This study assessed the impact of the first COVID-19 wave in England on outcomes for acute appendicitis, gallstone disease, intestinal obstruction, diverticular disease, and abdominal wall hernia.

Methods
Emergency surgical admissions for patients aged 18 years and older to 124 NHS Trust hospitals between January and June in 2019 and 2020 were extracted from Hospital Episode Statistics. The risk of 90-day mortality after admission during weeks 11–19 in 2020 (national lockdown) and 2019 (pre-COVID-19) was estimated using multilevel logistic regression with case-mix adjustment. The primary outcome was all-cause mortality at 90 days.

Results
There were 12 231 emergency admissions and 564 deaths within 90 days during weeks 11–19 in 2020, compared with 18 428 admissions and 542 deaths in the same interval in 2019. Overall, 90-day mortality was higher in 2020 versus 2019, with an adjusted OR of 1.95 (95 per cent c.i. 0.78 to 4.89) for appendicitis, 2.66 (1.81 to 3.92) for gallstone disease, 1.99 (1.44 to 2.74) for diverticular disease, 1.70 (1.13 to 2.55) for hernia, and 1.22 (1.01 to 1.47) for intestinal obstruction. After emergency surgery, 90-day mortality was higher in 2020 versus 2019 for gallstone disease (OR 3.37, 1.26 to 9.02), diverticular disease (OR 2.35, 1.16 to 4.73), and hernia (OR 2.34, 1.23 to 4.45). For intestinal obstruction, the corresponding OR was 0.91 (0.59 to 1.41). For admissions not leading to emergency surgery, mortality was higher in 2020 versus 2019 for gallstone disease (OR 2.55, 1.67 to 3.88), diverticular disease (1.90, 1.32 to 2.73), and intestinal obstruction (OR 1.30, 1.06 to 1.60).

Conclusion
Emergency admission was reduced during the first lockdown in England and this was associated with higher 90-day mortality.
Original languageEnglish
Pages (from-to)984–994
Number of pages11
JournalBritish Journal of Surgery
Volume109
Issue number10
Early online date27 Jul 2022
DOIs
Publication statusPublished - 1 Oct 2022

Bibliographical note

Funding Information:
The ESORT-C19 study is funded by the Health Foundation (grant number 2301232). The funder had no role in study design, data collection, analysis and interpretation of the findings.

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.

Keywords

  • surgery, emergency surgery, acute appendicitis, gallstone disease, diverticular disease, abdominal wall hernia, intestinal obstruction

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