ABSTRACT
OBJECTIVE:
We aimed to compare
general surgery emergency (GSE) volume, demographics and
disease severity before and during COVID-19.
BACKGROUND:
Presentations to the
emergency department (ED) for GSEs fell during the early COVID-19 pandemic. Barriers to accessing care may be heightened, especially for
vulnerable populations, and
patients delaying care raises
public health concerns.
METHODS:
We included
adult patients with ED presentations for potential GSEs at a single quaternary-care
hospital from January 2018 to August 2020. To compare GSE volumes in total and by subgroup, an interrupted
time-series
analysis was performed using the March
shelter-in-place order as the start of the COVID-19 period. Bivariate
analysis was used to compare demographics and
disease severity.
RESULTS:
3255
patients (28/week) presented with potential GSEs before COVID-19, while 546 (23/week) presented during COVID-19. When
shelter-in-place started, presentations fell by 8.7/week (31%) from the previous week (p<0.001), driven by decreases in
peritonitis (ß=-2.76, p=0.017) and
gallbladder disease (ß=-2.91, p=0.016). During COVID-19,
patients were younger (54 vs 57, p=0.001), more often privately insured (44% vs 38%, p=0.044), and fewer required interpreters (12% vs 15%, p<0.001). Fewer
patients presented with
sepsis during the
pandemic (15% vs 20%, p=0.009) and the average
severity of illness decreased (p<0.001).
Length of stay was shorter during the COVID-19 period (3.91 vs 5.50 days, p<0.001).
CONCLUSIONS:
GSE volumes and severity fell during the
pandemic.
Patients presenting during the
pandemic were less likely to be
elderly, publicly insured and have
limited English proficiency, potentially exacerbating underlying
health disparities and highlighting the need to improve care access for these
patients. LEVEL OF EVIDENCE III.