Gürkan ALTUNTAŞ, Murat Mümin YAZICI, Özlem BİLİR, Gökhan DEMİRAL, Gülcan Nur YILMAZ

COVID-19 Pandemisi Sırasında Acil Genel Cerrahi İhtiyacı Olan Hastaların Retrospektif Analizi

Giriş: COVID-19 salgınını önlemek için dünya çapında birtakım kısıtlama önlemleri benimsendi ve COVID-19 hasta sayısındaki artışla başa çıkmak için sağlık sistemleri yeniden düzenlendi. Bu çalışmamızın amacı, COVID-19 pandemi döneminin, acil servisimize başvuran acil cerrahi hastalığı olan ve acil genel cerrahi müdahale gerektiren hasta sayısı üzerindeki etkisini incelemektir. Yöntemler: COVID-19 pandemi sürecinde acil genel cerrahi yaklaşıma bakış açısını inceleyeceğimiz çalışmamız, retrospektif tek merkezli klinik bir çalışma olarak planlandı.11 Mart - 1 Haziran 2020 tarihleri arasında üçüncü basamak eğitim ve araştırma hastanesi acil servisine müracaat eden ve acil genel cerrahi değerlendirme ihtiyacı olan hastalar çalışma grubu olarak belirlendi. Kontrol grubu olarak ise bir önceki yılın aynı dönemi acil servise başvuran ve acil genel cerrahi değerlendirme ihtiyacı olan hastalar belirlendi. Her iki tarih aralığında çalışma ve kontrol grubundaki hastaların sayısı, demografik verileri, klinik bulguları, tanıları ve yapılan cerrahi müdahaleleri karşılaştırılması planlandı. Bulgular: Çalışmamızda, kontrol grubu ile kıyaslandığında, COVID-19 salgın dönemi olan çalışma grubunda başvuran hasta sayısında %12 lik bir azalma söz konusuydu. Çalışma ve kontrol grubu arasında operasyon kararı (p=0,001), operasyon tarzı (p=0,004) istatistiksel olarak anlamlıydı, ancak hastaneye başvuru süreleri, hastanede yatış süreleri ve mortalite istatistiksel olarak anlamsızdı. Sonuç: COVID-19 pandemisi, acil cerrahi ihtiyacı olan hastaların yönetimini etkilemiştir. Çalışma grubu kontrol grubu ile kıyaslandığında tedavi rejimi açısından daha az oranda cerrahi müdahale metodu içermekteydi. Ancak, her ne kadar medikal tedavi yöntemleri tercih edilse de, uygun endikasyonlarda cerrahi tedavi gerekliliğini ortadan kaldırmamıştır.

Anahtar Kelimeler:

Acil cerrahi, Acil tıp, COVID-19

A Retrospective Analysis of Patients in Urgent Need of General Surgery during the COVID-19 Pandemic

Introduction: Various restrictions were adopted across the world in order to prevent the COVID-19 pandemic, and health systems were reorganized in order to cope with increasing COVID-19 patient numbers. The purpose of this study was to examine the effect of the COVID-19 pandemic on the number of patients presenting to our emergency department with emergency surgical diseases and requiring urgent general surgery. Methods: This research examining the approach to emergency general surgery during the COVID-19 pandemic was planned as a retrospective, single-center, clinical study. Patients presenting to the emergency department of a tertiary training and research hospital between 11 March and 1 June, 2020 and requiring urgent general surgical evaluation constituted the study group. The control group consisted of patients presenting to the emergency department and requiring urgent general surgical evaluation during the same period in the previous year. We planned to compare the numbers of patients, their demographic data, the clinical findings, diagnoses, and surgical interventions between the two periods. Results: A 12% decrease was observed in the numbers of patients presenting in the study group during the COVID-19 pandemic compared to the control group. Decisions to operate (p=0.001) and types of operation(p=0.004) differed significantly between the patient and control groups, but no significant difference was observed in terms of hospital presentation times, length of hospital stay, or mortality. Conclusion: The COVID-19 pandemic has affected the management of patients requiring emergency surgery. In terms of the treatment regimen, fewer surgical methods were employed in the study group than in the control group. However, despite the preference for medical therapeutic methods, this did not eliminate the need for surgical treatment for appropriate indications.

Keywords:

Emergency surgery, Emergency medicine, COVID-19,

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1. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19) situation summary. Available from URL: https://www.cdc.gov/coronavirus/2019-ncov/summary.html (accessed March 2020).
2. Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M; FACS on behalf of the Associazione Chirurghi Ospedalieri Italiani (ACOI). Emergency general surgery in Italy during the COVID-19 outbreak: firs tsurvey from the real life. World J Emerg Surg. 2020 May 24;15(1):36.
3. Paules CI, Marston HD, Fauci AS. Coronavirus Infections-More Than Just the Common Cold. JAMA. 2020 Feb 25;323(8):707-708.
4. Guidance for health system contingency planning during wide spread transmission of SARS-CoV-2 with high impact on health care services. https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-guidance-health-systems-contingency-planning.pdf. Accessed 30 Mar 2020.
5. Cheeyandira A. The effects of COVID-19 pandemic on the provision of urgent surgery: a perspective from the USA. J Surg Case Rep. 2020 Apr 23;2020(4):rjaa109.
6. Krutsri C, Singhatas P, Sumpritpradit P, et al. Impact of the COVID-19 pandemic on the outcome, morbidity, and mortality of acute care surgery patients: A retrospective cohort study. Int J Surg Open. 2021 Jan;28:50-55. 7. Cano-Valderrama O, Morales X, Ferrigni CJ, et al. Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study. Int J Surg. 2020 Aug;80:157-161.
8. Italian Association of Hospital Surgeons (ACOI) and Italian Society of Surgery (SIC). ACOI-SIC recommendations during COVID-19 pandemic. Published 2020. Availableat:https://www.sicitalia.org/wp-content/uploads/2020/04/20200330_Covid-19-Acoi_Sic.pdf. Accessed May 18, 2020.
9. Gok AFK, Eryılmaz M, Ozmen MM, Alimoglu O, Ertekin C, Kurtoglu MH. Recommendations for Trauma and Emergency General Surgery Practice During COVID-19 Pandemic. Ulus Travma Acil Cerrahi Derg. 2020 Apr;26(3):335-342.
10. Gallo G, La Torre M, Pietroletti R, et al. Italian society of colorectal surgery recommendations for good clinical practice in colorectal surgery during the novel coronavirus pandemic. Tech Coloproctol. 2020;24(6):501–505.
11. Coccolini F, Perrone G, Chiarugi M, et al. Surgery in COVID-19 patients: operational directives. World journal of emergency surgery 2020;15(1):25.
12. American College of Surgeons. COVID-19: elective case triage guidelines for surgical care. Available from: https://www.facs.org/ covid19/ clinicalguidance/elective-case; 2020.
13. Tebala GD, Milani MS, Bignell M, et all; Covid ICE-International Collaborative. Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients. World J Emerg Surg. 2022 Jan 28;17(1):8.
14. Göksoy B, Akça MT, Inanç ÖF. The impacts of the COVID-19 outbreak on emergency department visits of surgical patients. Ulus Travma Acil Cerrahi Derg. 2020 Sep;26(5):685-692.
15. Rausei S, Ferrara F, Zurleni T, et al. Dramatic decrease of surgical emergencies during COVID-19 outbreak. J Trauma Acute Care Surg. 2020;89(6):1085-1091.