新型冠状病毒肺炎疫情对急诊科急性胆囊疾病的影响

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department.

作者信息

Sakong Dal, Choe Michael Sung Pil, Nho Woo Young, Park Chang Won

机构信息

Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Department of Emergency Medicine, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea.

出版信息

Clin Exp Emerg Med. 2023 Mar;10(1):84-91. doi: 10.15441/ceem.22.239. Epub 2023 Jan 9.

DOI:10.15441/ceem.22.239

PMID:37016736

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10090734/

Abstract

OBJECTIVE

Acute gallbladder disease (AGD) is frequent in the emergency department (ED) and usually requires emergency surgery. However, only a few studies have reported the impact of COVID-19 on AGD. The goal of this study was to evaluate the time between symptom onset and surgery and the perioperative severity of AGD during the COVID-19 pandemic compared to before the era of COVID-19.

METHODS

This retrospective, single-center cohort study included patients who presented to the ED with suspected AGD and who underwent emergency cholecystectomy. We designed a before-after comparative study, and the intervention was the COVID-19 outbreak. The 6-month period after the COVID-19 outbreak was defined as the post-COVID group, whereas the pre-COVID group consisted of the same period in the previous year. The primary outcome was the time from symptoms to surgery. We evaluated the time intervals between symptom onset and ED arrival and between ED arrival and surgery. The secondary outcomes were preoperative and postoperative severity indexes.

RESULTS

A total of 316 patients was analyzed. The post-COVID group showed longer duration from symptom onset to ED arrival (34.0 hours vs. 15.0 hours, P<0.001) and longer time interval from ED arrival to surgery (16.2 hours vs. 10.2 hours, P<0.001) than the pre-COVID group. The overall time interval between symptom onset to surgery was longer in the post-COVID group than the pre-COVID group (71.5 hours vs. 33.5 hours, P<0.001). The post-COVID group showed higher preoperative Simplified Acute Physiology Score II scores than the pre-COVID group (20.1 vs. 18.2, P=0.045). The proportion of moderate or severe disease increased in the post-COVID group (78% vs. 65%, P=0.017). The durations of hospital stay (7.0 days vs. 5.0 days, P<0.001) and intensive care unit stay (27.1 hours vs. 10.8 hours, P=0.008) were longer in the post-COVID group than in the pre-COVID group.

CONCLUSION

During the pandemic, the time interval between symptom onset to surgery was significantly increased among patients with AGD. Concomitantly, higher preoperative severity indexes and longer hospital stay were reported with a delay in emergency surgery.

摘要

目的

急性胆囊疾病（AGD）在急诊科很常见，通常需要急诊手术。然而，只有少数研究报道了COVID-19对AGD的影响。本研究的目的是评估COVID-19大流行期间与COVID-19时代之前相比，AGD患者症状出现至手术的时间以及围手术期的严重程度。

方法

这项回顾性单中心队列研究纳入了因疑似AGD就诊于急诊科并接受急诊胆囊切除术的患者。我们设计了一项前后对比研究，干预因素为COVID-19疫情爆发。将COVID-19疫情爆发后的6个月定义为COVID后组，而COVID前组由上一年的同一时期组成。主要结局是从症状出现到手术的时间。我们评估了症状出现至到达急诊科以及到达急诊科至手术的时间间隔。次要结局是术前和术后严重程度指标。

结果

共分析了316例患者。与COVID前组相比，COVID后组从症状出现到到达急诊科的时间更长（34.0小时对15.0小时，P<0.001），从到达急诊科到手术的时间间隔也更长（16.2小时对10.2小时，P<0.001）。COVID后组症状出现至手术的总体时间间隔比COVID前组长（71.5小时对33.5小时，P<0.001）。COVID后组术前简化急性生理学评分II得分高于COVID前组（20.1对18.2，P=0.045）。COVID后组中度或重度疾病的比例增加（78%对65%，P=0.017）。COVID后组的住院时间（7.0天对5.0天，P<0.001）和重症监护病房停留时间（27.1小时对10.8小时，P=0.008）比COVID前组长。