Lategan Conné, Wang Xiaoming, Chisholm Cassandra, Hsu Zoe, Lang Eddy
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Provincial Research Data Services, Alberta Health Services, Alberta SPOR SUPPORT Unit, Edmonton, AB, Canada.
CJEM. 2025 Feb;27(2):134-143. doi: 10.1007/s43678-024-00832-y. Epub 2025 Jan 3.
Postponing scheduled surgeries may alleviate emergency department (ED) crowding by increasing inpatient beds for ED patients but the impact of such measures are unclear. We determined if scheduled surgery cancellations for inguinal hernia and gallbladder disease during the coronavirus pandemic affected ED presentations, hospitalizations, and complications.
This database review included Albertans ≥ 18 with ED presentations for inguinal hernia and gallbladder disease from March 1, 2018 to May 31, 2022. The primary outcome examined ED hospitalizations and complications in the pre- (March 1, 2018-March 18, 2020) and post-cancellation (May 4, 2020-May 31, 2022) periods utilizing interrupted time series analysis. The secondary outcome reported scheduled surgery trends.
78,315 (10.6% inguinal hernia n = 8268; 89.4% gallbladder disease n = 70,064; n = 17 both inguinal hernia and gallbladder disease) patients were included. The post-cancellation period experienced a decreased trend change for inguinal hernia patients who received hospital admission (- 146.0%; p < 0.001), urgent interventions (- 171.0%; p < 0.001), and hernia repairs (- 164.0%; p < 0.001). For gallbladder disease patients, the post-cancellation period demonstrated a decreased trend in hospital admission (- 106.0%; p = 0.038) and an increased trend in day surgery transfers (- 1285.0%; p = 0.015) and median ED length of stay (82.0%; p = 0.0042). During the cancellation period, inguinal hernia and gallbladder disease surgeries decreased by 66.7% and 55.6%, respectively.
Despite a two-month surgery cancellation period, inguinal hernia and gallbladder disease patients demonstrated minimal differences in outcomes. During periods of ED boarding and crowding, scheduled surgery cancellations may be considered with minimal risk of potential adverse patient effects.
推迟预定手术可能会通过增加急诊患者的住院床位来缓解急诊科（ED）的拥挤情况，但此类措施的影响尚不清楚。我们确定了在冠状病毒大流行期间，腹股沟疝和胆囊疾病的预定手术取消是否会影响急诊科就诊、住院情况及并发症。
该数据库回顾纳入了2018年3月1日至2022年5月31日期间因腹股沟疝和胆囊疾病到急诊科就诊的18岁及以上的艾伯塔省居民。主要结局通过中断时间序列分析，研究取消手术前（2018年3月1日至2020年3月18日）和取消手术后（2020年5月4日至2022年5月31日）期间的急诊科住院情况及并发症。次要结局报告预定手术趋势。
共纳入78315例患者（腹股沟疝占10.6%，n = 8268；胆囊疾病占89.4%，n = 70064；腹股沟疝和胆囊疾病均有的占17例）。对于接受住院治疗的腹股沟疝患者，取消手术后期间住院人数（-146.0%；p < 0.001）、紧急干预（-171.0%；p < 0.001）和疝修补手术（-164.0%；p < 0.001）呈下降趋势。对于胆囊疾病患者，取消手术后期间住院人数呈下降趋势（-106.0%；p = 0.038），日间手术转院人数呈上升趋势（-1285.0%；p = 0.015），急诊科中位住院时间呈上升趋势（82.0%；p = 0.0042）。在取消手术期间，腹股沟疝和胆囊疾病手术分别减少了66.7%和55.6%。
尽管有为期两个月的手术取消期，但腹股沟疝和胆囊疾病患者的结局差异极小。在急诊科滞留和拥挤期间，可考虑取消预定手术，且对患者产生潜在不良影响的风险极小。
