General surgery admissions, operations, and patient outcomes during the COVID-19 pandemic

Document Type : Original Article


1 Assistant Professor of Surgery, Department of Surgery, Kashan University of Medical Sciences, Kashan, Iran

2 MSc in Biostatistics, Infectious Disease Research Center, Kashan University of Medical Sciences, Kashan, Iran

3 Resident, Department of General Surgery, Kashan University of Medical Sciences, Kashan, Iran

4 Professor of Radiology, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

5 Assistant Professor of Surgery, Department of Surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

6 Professor of Epidemiology, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran



Background and Objectives: During the COVID-19 pandemic, hospitals were overwhelmed and non-COVID admissions were restricted due to national guidelines and decreased references. The aim of this study was to evaluate the collateral effect of the pandemic on general surgery admissions, operations, and patient outcomes. Patients and Methods: After the ethics committee approval for this retrospective descriptive study, all general surgery patients from February 23 to May 21, 2020, were compared with a similar timeframe in 2019. Time from symptom onset to admission, final diagnosis, and type of surgery was documented. Morbidity and mortality rate, intensive care unit (ICU) admission time, and total admission time were compared. Results: During the first COVID-19 surge, a 64% decrease in admissions was observed. The mean time from symptom onset to admission showed a significant delay of 1.2 days. Fewer patients were admitted to the ICU, but ICU admission time was longer. Total admission time and postoperative surgical and nonsurgical complications showed no significant difference. The rate of complicated appendicitis increased from 2.8% to 12.3% of total surgeries. A decrease in total trauma admissions was observed, but trauma operations remained unchanged, and penetrating trauma admissions had doubled. Conclusion: Although morbidity and mortality were not increased during the pandemic, increased time to admission, under triage of trauma patients, shortage of ICU beds, and a higher rate of complicated appendicitis portray the collateral effects of the pandemic on general surgery patient care. The increased number of penetrating injuries demands psychological support during home confinement. Efforts should be made to maintain maximal surgical care during pandemics.


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