Effect of the COVID-19 Pandemic in Jerusalem on Acute Care Surgery

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Background: Concerns were raised about the effect of the COVID-19 pandemic on patient morbidity because of delayed presentation to the hospital. This study aimed to assess the effect of the pandemic on the timing and severity of presentation to acute surgical care.Methods: We retrospectively reviewed the medical charts of patients hospitalized in the General Surgery Department at Hadassah University Medical Center from March to August 2020. We evaluated patients diagnosed with four acute surgical diseases, including acute appendicitis (AA), acute diverticulitis (AD), acute cholecystitis (AC), and bowel obstruction (BO). For the control group, we reviewed similar cases from March to August 2019. We compared patient demographics, time intervals from arrival to the Emergency Department (ED) to diagnosis and operation if needed, surgical and in-hospital course, and severity of the diseases.Results: The study included 376 patients, 242 in the control cohort and 134 in the COVID-19 cohort. The number of referrals and hospitalizations to the surgical department was significantly smaller in the COVID-19 cohort (p = 0.015). In the COVID-19 cohort, the time intervals for physicians' examination, imaging, and surgery were shorter (p = 0.010), but the time intervals for hospitalization were longer (p < 0.001). Also, the percentage of BO cases was higher (34.3% vs. 23.4%, p = 0.087), and the length of operations was longer (p = 0.058) in this cohort. No differences were found in the duration of symptoms, length of intensive care unit hospitalization, the severity of cases, or the course of hospitalization.Conclusion: COVID-19 led to a significant decrease in referrals and urgent surgical hospitalizations during the pandemic without worsening of the patient condition. According to our study, some of the common surgical diseases may be managed conservatively without hospitalization.

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