First wave of COVID-19 impact on emergency general surgery in a Spanish tertiary hospital. A cohort study.

INTRODUCTION: The need to care for patients with emergency symptoms still continues during the COVID-19 pandemic. The number of emergency surgery procedures performed in Spanish hospitals decreased significantly during the first wave of COVID-19. PATIENTS AND METHODS: We performed a retrospective cohort study comparing the emergency surgery activity in a Spanish tertiary Hospital during the COVID-19 pandemic and emergency surgery activity registered in 2019 during the equivalent time period. RESULTS: A total of 1802 patients were included in control group (CG) versus 756 in pandemic group (PG). Mean number of patients who underwent emergency surgery during the control and pandemic periods was 3.42 patients per day, in contrast to 1.62 during the pandemic period, which represents a 52.6% decrease in emergency surgery activity. During the pandemic period, most of the patients consulted after more than 72 h of symptoms, representing a delay in presenting in the ER of 23.7% when compared to CG. Surgeries due to complications from previous elective procedures decreased (12% vs. 6.1%) in PG, probably because elective procedures are being postponed. We had a 13.1% COVID-19 positivity rate. Morbidity was higher during pandemic (52.5% vs. 35.2%). Mortality rates in patients undergoing emergency surgery was higher in PG (12.1% vs. 4.8%). CONCLUSIONS: The impact of the first wave of COVID-19 in emergency surgery activity has been profound. A significant reduction in emergency surgery was observed, along with longer time periods between patients' onset of symptoms and their arrival at the Emergency Department. Higher morbidity was also observed during the pandemic period.

Impacto de los métodos de diagnóstico por imagen en la apendicectomía de urgencia / Impact of imaging tests on the negative appendectomy rate

Introducción. Las apendicectomías negativas y gangrenadas son indicadores de calidad en cirugía general. Los objetivos de este estudio son analizar las apendicectomías de urgencia en relación con el uso de pruebas de imagen y revisar la bibliografía para analizar la calidad del proceso diagnóstico en la apendicitis aguda. Material y métodos. Estudio retrospectivo en el que se incluyeron todos los pacientes a los que se les realizó apendicectomía de urgencia por sospecha de apendicitis aguda en el Hospital Universitario 12 de Octubre de Madrid durante el año 2007. Los datos se obtuvieron de los informes de anatomía patológica y de las pruebas de imagen realizadas. Se analizaron la histología, las pruebas de imagen empleadas y su utilidad diagnóstica. Se compararon con los niveles de calidad publicados en la literatura médica internacional. Resultados. Se incluyeron en el estudio 394 pacientes. La tasa de apendicectomías negativas fue del 9,6%. Se le realizó ecografía (ECO) abdominal al 54,6% de los pacientes y tomografía axial computarizada (TAC) abdominal al 10,2% de los pacientes (TAC+ECO: 4,2%). El valor predictivo positivo de la ECO fue del 92,2% y el de la TAC fue del 97,5%. Conclusión. Las apendicectomías negativas (9,6%) muestran valores inferiores a los publicados históricamente, pero son más elevados que los publicados recientemente en EE. UU. El uso de técnicas de imagen en nuestro medio es inferior al publicado en EE. UU., aunque similar al de otros países europeos(AU)

Introduction. Negative appendectomies and perforated appendectomies have traditionally been quality indicators in surgery. The aim of this study is to analyze the emergency appendectomies in our hospital regarding the use of imaging tests and a review of the literature to analyze the quality of diagnosis in acute appendicitis. Material and methods. Retrospective study including all patients operated on for suspected acute appendicitis at a single institution for one year (2007). Data gathered from histology and imaging tests reports. Analysis of the histology results, imaging test used and its diagnostic accuracy. Comparison with quality levels published in the international literature. Results. A total of 394 patients were included in the study, the overall rate of negative appendectomy was 9.6%. Abdominal ultrasound (AU) was performed on 54.6% of patients and abdominal CT-scan on 10.2% of them, and 4.2% of the patients had both tests. AU positive predictive value was 82%. CT-scan positive predictive value was 97%. Conclusion. The negative appendectomy rate (9.6%) in our centre shows values lower than the published ones in historical series but superior to the one published recently in the USA. The use of imaging tests in our hospital is lower than the one published in the USA, although similar to data reported in other European countries(AU)

[Impact of imaging tests on the negative appendectomy rate]. / Impacto de los métodos de diagnóstico por imagen en la apendicectomía de urgencia.

INTRODUCTION: Negative appendectomies and perforated appendectomies have traditionally been quality indicators in surgery. The aim of this study is to analyze the emergency appendectomies in our hospital regarding the use of imaging tests and a review of the literature to analyze the quality of diagnosis in acute appendicitis. MATERIAL AND METHODS: Retrospective study including all patients operated on for suspected acute appendicitis at a single institution for one year (2007). Data gathered from histology and imaging tests reports. Analysis of the histology results, imaging test used and its diagnostic accuracy. Comparison with quality levels published in the international literature. RESULTS: A total of 394 patients were included in the study, the overall rate of negative appendectomy was 9.6%. Abdominal ultrasound (AU) was performed on 54.6% of patients and abdominal CT-scan on 10.2% of them, and 4.2% of the patients had both tests. AU positive predictive value was 82%. CT-scan positive predictive value was 97%. CONCLUSION: The negative appendectomy rate (9.6%) in our centre shows values lower than the published ones in historical series but superior to the one published recently in the USA. The use of imaging tests in our hospital is lower than the one published in the USA, although similar to data reported in other European countries.