Operative versus non-operative management in acute surgical diseases during COVID-19 pandemic: a 30-day experience from an Italian hospital in Lombardy.

The spread of COVID-19 pandemic has determined a huge imbalance between real clinical needs of the population and effective resources availability. The aim of this study was to report how this situation forces surgeons to consider a non-operative management as an alternative. This is a retrospective monocentric study and we collected data from 60 patients, split in two groups: info from Group A, 28 patients (11 March to 11 April 2020) were compared with info from group B, 32 patients (11 March to 11 April 2019). The most relevant difference between the groups is related to patient's clinical management. The two groups had a considerably different number of cases that were treated with an operative management: 18 cases (64,7%) in group A vs. 28 cases (87,5%) in group B. Otherwise, non-operative approach occurred in 10 cases (35,7%) in group A and only in 4 patients (12,5%) in group B. These data suggest that the drastic reduction of means narrows the range of therapeutic choices. Indeed, in this emergency scenario, the rationing of healthcare resources was the propelling for surgeons to consider alternative therapeutic pathways.