Riley John S, Luks Valerie L, de Pina Luis Filipe, Al Adas Ziad, Stoecker Jordan B, Jackson Benjamin M, Braslow Benjamin M, Holena Daniel N
21798 Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Am Surg. 2020 Nov;86(11):1492-1500. doi: 10.1177/0003134820949506. Epub 2020 Aug 29.
The coronavirus disease 2019 (COVID-19) pandemic significantly reduced elective surgery in the United States, but the impact of COVID-19 on acute surgical complaints and acute care surgery is unknown.
A retrospective review was performed of all surgical consults at the Hospital of the University of Pennsylvania in the 30 days prior to and 30 days following confirmation of the first COVID-19 patient at the institution. Consults to all divisions within general surgery were included.
Total surgical consult volume decreased by 43% in the post-COVID-19 period, with a significant reduction in the median daily consult volume from 14 to 8 ( < .0001). Changes in consult volume by patient location, chief complaint, and surgical division were variable, in aggregate reflecting a disproportionate decrease among less acute surgical complaints. The percentage of consults resulting in surgical intervention remained equal in the 2 periods (31% vs 28%, odds ratio 0.85, 95% CI 0.61-1.21, = .38) with most but not all operation types decreasing in frequency. The rise in the COVID-19 inpatient census led to increased consultation for vascular access, accommodated at our center by the creation of a new surgical procedures team.
The COVID-19 pandemic significantly altered the landscape of acute surgical complaints at our large academic hospital. An appreciation of these trends may be helpful to other Departments of Surgery around the country as they deploy staff and allocate resources in the COVID-19 era.
2019年冠状病毒病(COVID-19)大流行显著减少了美国的择期手术,但COVID-19对急性外科疾病和急性护理手术的影响尚不清楚。
对宾夕法尼亚大学医院在该机构确诊首例COVID-19患者之前30天和之后30天内的所有外科会诊进行了回顾性研究。纳入了普通外科所有科室的会诊。
COVID-19疫情后,外科会诊总量下降了43%,每日会诊量中位数从14显著降至8(<0.0001)。按患者所在地、主要诉求和外科科室划分的会诊量变化各不相同,总体反映出病情不太严重的外科疾病会诊量下降幅度不成比例。两个时期导致手术干预的会诊百分比保持相等(31%对28%,优势比0.85,95%置信区间0.61 - 1.21,P = 0.38),大多数但并非所有手术类型的频率都有所下降。COVID-19住院患者普查人数的增加导致血管通路相关会诊增加,我们中心通过组建一个新的外科手术团队来应对这一情况。
COVID-19大流行显著改变了我们大型学术医院急性外科疾病的格局。了解这些趋势可能有助于美国其他外科科室在COVID-19时代调配人员和分配资源。