RCSI study highlights the impact of pandemic on patients having emergency surgery

Patients undergoing emergency abdominal surgery spent less time in hospital during COVID-19, without any negative impact on outcomes, according to a new study from RCSI National Clinical Programme in Surgery and the Health Outcomes Research Centre at RCSI.

The findings support national policy to separate non-emergency and emergency abdominal surgery (EAS) in Irish hospitals.

At the onset of the COVID-19 pandemic, admissions for emergency general surgery reduced throughout Europe and elsewhere. In Irish hospitals, as in other countries, all non-emergency surgery was cancelled and emergency surgery was only performed in cases where there was an acute threat to life or well-being. The changes brought about by the pandemic resulted in a public health system that prioritized emergency surgery.

This RCSI study analyzed data from patients admitted for EAS to 24 Irish hospitals, before and during the pandemic, between 2018 and 2020. The research aimed to understand the impact of the pandemic on patients having an emergency surgery by analyzing a range of factors including the numbers of patients admitted, the illnesses they were admitted with, length of hospital stay and patient outcomes.

The findings reveal that there was an almost 20% decrease in EAS during the pandemic but no difference in the illnesses requiring admission nor in the commonest surgical procedures being performed. The average length of stay in hospital reduced by 5 days during the first wave of COVID-19 in February – June 2020 and by 3.5 days during the second wave of COVID-19 in July – November 2020.

The findings indicate that the separation of non-emergency from emergency surgery that was necessitated by the pandemic, improved hospital efficiencies while preserving patient outcomes after emergency abdominal surgery.

Joel Rajesh, research student with the National Clinical Programme in Surgery, RCSI, said: ‘Emergency abdominal surgery is performed in the treatment of a range of conditions including appendicitis, bowel problems and hernias. Patients undergoing these surgeries can have a prolonged length of stay in hospital, which can lead to longer waiting lists for beds in hospitals as well as inconvenience for and increased risk to patients.’

National policy has long recommended the separation of scheduled and unscheduled surgery in Irish hospitals to improve emergency care. The pandemic made this a necessity and it has shown that separating emergency and non-emergency surgery in the case of emergency abdominal surgery, works, and brings benefits to both patients and hospitals.’”

Gintare Valentelyte, PhD Research Scholar, Health Outcomes Research Centre, RCSI

In the study, it was also found that most patients (92%) were admitted for EAS from home. Patients over 80 comprised 18% of those admitted for EAS during COVID, an increase of 2% on pre-COVID.

Further analysis by this research team of the system changes responsible for the improvements will enable continued progress in the delivery of high quality, safe and efficient emergency abdominal surgery in Ireland.

This report is the result of a research collaboration between the RCSI National Clinical Programme in Surgery (NCPS) and the Health Outcomes Research Centre at RCSI.