Changing the nature of benign entities during the pandemic. A riddle asking for solution?

Résumé fourni par la source

Dear editor, We have read with interest the article published by Palisi et al.1 about decreased hospital admissions, as far as emergency operations are concerned. Herein, we report our experience from a tertiary university hospital in Greece, covering a population of approximately 1.5 million people. Undoubtedly, the causes of sharp reduction of emergency surgical cases during COVID-19 are possibly multifactorial, reflecting a highly concerning and alarming situation with serious implications for public health. In our correspondence, we report the number of operations we have performed for non-complicated and complicated cases of appendicitis and cholecystitis, comparing periods before and after the initiation of the pandemic. We have chosen to include mainly these surgical pathologies, because they are among the most common surgical cases encountered, along with a compelling observation as far as their severity is concerned. In contrast with other studies, we have not observed a statistically significant difference between the total numbers of patients admitted for acute conditions between the two examined periods(494 vs 471). Interestingly enough, we report that the severity of phenomenally benign entities like appendicitis and cholecystitis shows trends of changing. More specifically, people admitted to our department during the pandemic presented with more complicated cases(i.e. perforation, gangrenous presentation), when compared with people admitted before this era (P < 0.05). Moreover, hospital stay and duration of operations have both increased, a fact that also justifies our conclusion that patients come to the hospital with delayed presentation. Undoubtedly, these results must be interpreted by health administrators worldwide with caution and solutions to improve healthcare access must be implemented, while simultaneously maintaining the integrity of the COVID-19 control measures. Ultimately, there are serious concerns that are raised, whether benign entities like appendicitis and cholecystitis will change their morbidity and mortality rates, a fact that may be associated with delayed presentation. None. None. The authors have no other conflicts of interest to declare.

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