The impact of hospital strategy to quarantine COVID-19 cases on the care efficiency and surgical outcome in patients with acute abdomen in Taiwan

Abstract text (incl. references and figure legends)

Purpose:

To investigate the impact of COVID-19 on the care system and surgical outcome in patients with acute abdomen.

Materials and methods:

We reviewed 4426 acute abdomen patients operated for three emergency conditions of bowel ischemia, intestinal obstruction and hollow organ perforation and a less urgent acute appendicitis. For comparison, we divided the time frame into 3 specific time periods: period 1: 2017/1-2019/12, pre-COVID-19 era, n=2556; period 2: 2020/1-2022/03, n=1693; and period 3: 2022/4-2022/7, n=177. During period 2, it was mandatory for patients with COVID-19 infection or travel/contact history to be operated in a negative-pressurized operation room, while during time period 3, exposure history was neglected and only confirmed cases were operated with special precautions.

Results:

Compared to patients of pre-COVID era, after COVID-19 outbreak, the time interval from surgical consultation to operation was significantly prolonged for patients without COVID-19 infection, and was even longer for patients with COVID-19 infection (2.2 (1.3-3.0) vs 2.4 (1.5-3.9) vs 5.2 (2.2-10.4) hrs for each group, p<0.001). Further analysis revealed time prolongation only occurred in the appendicitis cases (2.4 vs 3.8 vs 10.1 hrs, p<0.001) but not emergency cases (2.1 vs 1.9 vs 2.7 hrs, p=0.743). The similar pattern of non-delay in emergency case can also be demonstrated when comparing the three time periods (2.4 vs. 3.6 vs. 9.3 hrs in appendicitis cases, p<0.001; 2.1 vs. 2.1 vs. 2.0 hrs in emergency cases, p=0.632). Nonetheless, the post-operative length of hospital stay and peri-operative morbidity were similar between Pre- and Post-COVID-19 era, while higher disease-related mortality in emergency cases was observed after COVID-19 outbreak

Conclusion:

The COVID-19 pandemic significantly changed disease pattern and clinical practice for patients with acute abdomen. However, the quality of care for emergent acute abdomen cases was not affected.

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