The Early Changes in Emergency General Surgery Following Implementation of UK COVID-19 Policy: A Retrospective Cohort Study

Abstract

Introduction Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. On 23rd March 2020, the UK introduced measures in an effort to curb the disease spread. The aim of this study was to analyse the effect of government and Royal College measures on the general surgical take. Materials and methods A retrospective analysis of patients referred to the acute general surgical take between 2nd March 2020 and 5th April 2020, including acuity at the time of referral, management, and patient outcomes, was undertaken. Data fit into a 'pre-COVID measures' cohort (prior to 23rd March 2020) and a 'post-COVID measures' cohort (on or after 23rd March 2020). Results A total of 465 patient referrals were included. There was a decrease in admissions rate in the post-COVID measures' cohort (p=0.001), but with an increase in patient acuity with white cell count (WCC) (p=0.024) and C-reactive protein (CRP) (p=0.036). Laparoscopic surgery decreased (p=0.004); however, the proportion of patients having an operation remained constant. There was no increase in short-term morbidity and mortality or length of stay (LOS). Discussion The data suggests that UK lockdown introduction influenced people's behaviour. Fewer patients presented to the surgical take; however, these patients were of higher acuity. Despite changes in royal college guidelines, there was no decrease in the proportion of patients undergoing operations; however, a higher proportion were open procedures. The change in national and college guidelines did not affect short-term morbidity, mortality or LOS.