Covid-19'un Acil Cerrahi Vakalar Üzerindeki Etkisi. Yüksek Hacimli Bir Şehirden Veriler.

Amaç COVID -19 dünya çapında sağlık sistemi üzerinde muazzam ve öngörülemeyen bir yük oluşturdu. Elektif genel cerrahi uygulamalarına ek olarak, acil cerrahi vakalarına yaklaşım ve hastaların hastanelere kabulleri de bu beklenmedik sonuçtan ciddi şekilde etkilenmiştir. Burada, şehrimizde acil cerrahi müdahale gerektiren olgularda kayda değer azalmaya dikkati çekmeyi ve bu durumu açıklamaya çalışmayı amaçlıyoruz. Yöntem Bu çok merkezli retrospektif çalışmada, Sakarya ilinde, pandemi öncesi (Ocak 2020- Şubat 2020) ve pandeminin akut fazı (Mart 2020 Ortası- 2020 Ortası) dönemlerinde yapılan acil cerrahi ameliyatlar karşılaştırılmıştır. Bulgular Pandemi öncesi hastaların cinsiyete göre dağılımı erkek hastalarda %53.1, kadın hastalarda %46.9, pandemi sırasında kadınlarda % 61.6 ve kadın hastalarda %38.4 idi. Hastaların ortalama yaşı pandemi öncesi 54.72 ± 3.65 ve pandemi sırasında 38.54 ± 2.32 idi ve acil cerrahi geçiren hastaların yaş dağılımı açısından istatistiksel olarak anlamlı fark vardı (p <0.05). Pandemi öncesi iki ay boyunca, toplam 290 acil ameliyat yapılırken, akut pandemik dönemde, aynı zaman aralığında 164 acil operasyon gerçekleştirildi. Pandemik dönemde acil cerrahi geçiren hasta sayısında pandemik olmayanlara göre istatistiksel olarak anlamlı bir azalma vardı (p = 0.012). Sonuç Acil cerrahi işlem gerektiren durumlarda azalmanın nedenleri kısmen tanımlanabilir. Bununla birlikte, değişiklik nedenleri şu anda açıklanamayan hastalık gruplarının, gelecekte istenmeyen sonuçları ile karşılaşmamak için daha ayrıntılı stratejik hazırlığa ihtiyaç olabilir.

Anahtar Kelimeler:

Covid-19, Pandemi, Cerrahi, Acil Cerrahi

The effect of Covid-19 on Emergency Surgical Cases. Data From a High-Volume City.

Objective COVID -19 placed a tremendous and unforeseen burden on the health system worldwide. In addition to the general surgery practice, the approach to emergency surgery cases, and patients’ admissions to the hospitals were also seriously affected by this unexpected consequence. Herein we aim to pay attention to the notable decrease in cases requiring urgent surgical intervention in our city and to try to explain this upshot. Methods In this multicenter retrospective study, emergency general surgical interventions performed in the 3rd and 2nd stage private and public hospitals, before the pandemic (January 2020- February 2020), and acute phase of the pandemic (Mid-March 2020 - Mid-May 2020) in Sakarya province were compared. Results The distribution of patients before pandemic by gender was 53.1% in male patients, 46.9% in female patients, while 61.6% in male, and 38.4% in female patients during the pandemic respectively. The mean age of patients was 54.72±3.65 before pandemic and 38.54±2.32 during the pandemic, and there was a statistically significant difference in terms of the age distribution of patients undergoing emergency surgery (p<0.05). During the two months before the pandemic, a total of 290 emergency surgeries were performed, while in the acute pandemic period, 164 emergency operations were performed in the same time interval. There was a statistically significant decrease in the number of patients undergoing emergency surgery during the pandemic period compared to non-pandemic (p= 0.012). Conclusion Although the causes for the decrease in cases requiring emergency surgery may be partially defined. However, the disease groups whose alteration reasons cannot be explained at the moment may need further detailed strategic preparation in order not to encounter undesired results in the future.

Keywords:

Covid-19, Pandemic, Surgery, Emergency Surrgery,

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Li X, Cui W, Zhang F. Who Was the First Doctor to Report the COVID-19 Outbreak in Wuhan, China? J Nucl Med. 2020;61(6):782-83.
N. Zhu et al. China Novel Coronavirus Investigating and Research Team. N Engl J Med. 2020;382(8):727-33.
American College of Surgeons Committee on Trauma. Maintaining Trauma Center Access and Care during the COVID-19 Pandemic: Guidance Document for Trauma Medical Directors. March 17. 2020; https://www.facs.org/covid-19/clinical-guidance/maintaining-access.
European Association for Endoscopic Surgery. EAES and SAGES Recommendations Regarding Surgical Response To Covid-19 Crisis. Eur Assoc Endosc Surg Guidel. 2020; https://www.sages.org/recommendationssurgical-response-covid-19/.
Çolakoğlu MK, Öter V, Bostancı EB, Özmen MM, Sarıbeyoğlu K. Surgical management of digestive system cancers during the coronavirus disease 2019 pandemic: review of general suggestions. Turk J Surg 2020; 36 (2): 121-31.
Tao KX, Zhang BX, Zhang P, Zhu P, Wang GB, Chen XP. Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation. Zhonghua Wai Ke Za Zhi. 2020; 58(3):170-77.
American College of Surgeons. COVID-19 : Recommendations for Management of Elective Surgical Procedures. American College of Surgeons. 2020. https://www.facs.org/about-acs/covid-19/information-for-surgeons.
Sezer A, Cicin İ, Karadeniz Çakmak G, Özkan Gürdal S, Başaran G, Oyan B et al. Turkish national consensus on breast cancer management during temporary state of emergency due to COVID-19 outbreak. Turk J Surg. 2020;36(2):147–63.
Moletta L, Pierobon ES, Capovilla G, Costantini M, Salvador R, Merigliano S, et al. International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg. 2020;79:180-88.
Patriti A, Eugeni E, Guerra F. What happened to surgical emergencies in the era of COVID-19 outbreak? Considerations of surgeons working in an Italian COVID-19 red zone. Updates Surg. 2020;72(2):309-10.
Berardi G, Levi Sandri GB, Colasanti M, Ettorre GM. Readaptation of surgical practice during COVID-19 outbreak: what has been done, what is missing and what to expect. Br J Surg. 2020;107(8):e251.
Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M, Beatrice DV, et al. Emergency general surgery in Italy during the COVID-19 outbreak: First survey from the real life. World J Emerg Surg. 2020;15(1):36.
Cano-Valderrama O, Morales X, Ferrigni CJ, Martín-Antona E, Turrado V, García A, et al. Reduction in emergency surgery activity during COVID-19 pandemic in three Spanish hospitals. Br J Surg. 2020;107(8):e239.
Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A, et al. Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: A systematic review and meta-analysis. Ann Surg. 2019;270(6):1028-40.
Di Saverio S, Sibilio A, Giorgini E, Biscardi A, Villani S, Coccolini F, et al. The NOTA study (non operative treatment for acute appendicitis): Prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260(1):109-17.