Ann Ital Chir. 2023;94:195-202.
COVID-19 is having a worldwide impact on surgical treatment. Our aim was to investigate the impact of the pandemic in a rural hospital serving a low densely populated area.
We investigated the volume and type of surgical performed operations during both the pandemic (March 2020 - February 2021) and pre-pandemic periods (March 2019 - February 2020) as well as during the first and second pandemic waves compared to the pre-pandemic period. We compared the volume and timing of emergency appendectomy and cholecystectomy performed during the pandemic with those of the pre-pandemic period, doing the same with the volume, timing and stages of elective gastric and colorectal resections for cancer.
In the pre-pandemic period a higher number of appendectomies (42 vs. 24) and urgent and elective cholecystectomies (174 vs. 126) was performed. The patients operated during the pandemic period (both for appendectomy and cholecystectomy) were on average older (58 vs. 52 years old, p=0.006), including for cholecystectomy (73 vs. 66 years old, p=0.01) and appendectomy (43 vs. 30 years old, p =0.04). The logistic regression analysis with regard to the cholecystectomies and appendectomies performed in emergency showed that male sex and age were associated with gangrenous type histology, both in the pandemic and pre-pandemic period. Finally, we found a reduction in the stage I and IIA colorectal cancers operated during the pandemic compared to those of the pre-pandemic period, with no increase of the advanced stages.
The reduction in services imposed by governments during the first months of total lock down could not justify the whole decrease in surgical interventions in the year of the pandemic. Data suggest that greater "non-operative management" for appendicitis and acute cholecystitis does not lead to an increase of cases operated over time, nor to an increase in the "gangrenous" pattern, this seems to depend on age advanced and male population.
COVID-19, Emergency Surgery, General Surgery, Pandemics.
COVID-19 正在对全球的外科治疗产生影响。我们的目的是研究大流行对一家服务于人口稀少的农村医院的影响。
我们调查了大流行期间（2020 年 3 月至 2021 年 2 月）和大流行前时期（2019 年 3 月至 2020 年 2 月）以及大流行期间的第一波和第二波与大流行前时期相比，手术的数量和类型。我们比较了大流行期间和大流行前时期进行的紧急阑尾切除术和胆囊切除术的数量和时间，并对癌症的择期胃和结直肠切除术的数量、时间和分期进行了相同的比较。
在大流行前时期，进行了更多的阑尾切除术（42 例与 24 例）和紧急和择期胆囊切除术（174 例与 126 例）。大流行期间接受手术的患者（阑尾切除术和胆囊切除术）的平均年龄更大（58 岁与 52 岁，p=0.006），包括胆囊切除术（73 岁与 66 岁，p=0.01）和阑尾切除术（43 岁与 30 岁，p=0.04）。关于紧急情况下进行的胆囊切除术和阑尾切除术的逻辑回归分析表明，在大流行和大流行前时期，男性和年龄与坏疽型组织学有关。最后，我们发现大流行期间接受手术的 I 期和 IIA 期结直肠癌数量减少，而晚期病例数量没有增加。
在全面封锁的头几个月，政府实施的服务减少，无法证明大流行年份外科手术干预的全面减少是合理的。数据表明，对阑尾炎和急性胆囊炎进行更多的“非手术治疗”并不会随着时间的推移导致手术病例的增加，也不会导致“坏疽”模式的增加，这似乎取决于年龄的增长和男性人口。
COVID-19、急诊外科、普通外科、大流行。
