Emergency abdominal surgery during a pandemic-related lockdown: a Vietnamese experience
DOI:
https://doi.org/10.18203/2349-2902.isj20261162Keywords:
COVID-19, Emergency abdominal surgery, Lockdown, Appendicitis, Peptic ulcer perforationAbstract
Background: The fourth wave of COVID-19 in Vietnam was associated with prolonged lockdown measures that may have influenced access to emergency surgical care. This study evaluated temporal changes in operative volume, prehospital presentation, disease severity, and early postoperative outcomes in common emergency abdominal conditions across distinct pandemic phases.
Methods: A retrospective study was conducted at a tertiary referral center, including adult patients undergoing surgery for appendicitis, cholecystitis, peptic ulcer perforation, and bowel obstruction during three periods: social distancing (June–September 2020), lockdown (June–September 2021), and post-lockdown (March–June 2022). Variables included demographic characteristics, prehospital symptom duration, disease severity graded by the American Association for the Surgery of Trauma (AAST) classification, and postoperative complications classified by Clavien–Dindo.
Results: A total of 1,251 patients were included. During lockdown, emergency operative volume decreased by approximately 50% compared with the social distancing period. Delayed presentation (>1 day) increased significantly in appendicitis and peptic ulcer perforation (p<0.01), accompanied by higher proportions of AAST Grade III–IV disease in both groups. No significant differences were observed in cholecystitis or bowel obstruction. Postoperative morbidity remained stable overall, except for an increase in moderate-to-severe complications in peptic ulcer perforation during lockdown (p=0.02). After lifting restrictions, operative volume, severity distribution, and early outcomes returned to pre-lockdown patterns.
Conclusions: During the lockdown period of Vietnam’s fourth COVID-19 wave, reductions in surgical volume and delayed presentation were observed in selected time-sensitive abdominal emergencies, accompanied by higher anatomic severity and morbidity in perforation cases. These patterns were not observed in the period following restoration of healthcare access.
References
Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021;19:141-54.
Li JY, You Z, Wang Q, Zhou ZJ, Qiu Y, Luo R, et al. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect. 2020;22:80-5.
Atri S, Hadad A, Makni A, Kacem MJ. Digestive surgical emergencies during the COVID-19 pandemic are deeply affected and more advanced. J Visc Surg. 2021;158:92-3.
Balvardi S, Cipolla J, Touma N, Vallipuram T, Barone N, Sivarajan R, et al. Impact of the COVID-19 pandemic on rates of emergency department utilization and hospital admission due to general surgery conditions. Surg Endosc. 2022;36:6751-59.
Mulita F, Sotiropoulou M, Vailas M. A multifaceted virus. Non-reducible and strangulated effects of COVID-19. J Trauma Acute Care Surg. 2021;91:e34.
Minh LHN, Quan NK, Le TN, Khanh PNQ, Huy NT. COVID-19 Timeline of Vietnam: Important Milestones Through Four Waves of the Pandemic and Lesson Learned. Front Public Health. 2021;9:709067.
Charlson M, Wells MT, Ullman R, King F, Shmukler C. The Charlson Comorbidity Index Can Be Used Prospectively to Identify Patients Who Will Incur High Future Costs. PLoS One. 2014;9:e112479.
Tominaga GT, Staudenmayer KL, Shafi S, Schuster KM, Savage SA, Ross S, et al. The American Association for the Surgery of Trauma grading scale for 16 emergency general surgery conditions: Disease-specific criteria characterizing anatomic severity grading. J Trauma Acute Care Surg. 2016;81(5):593-602.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
Kurihara H, Marrano E, Ceolin M, Chiara O, Faccincani R, Bisagni P, et al. Impact of lockdown on emergency general surgery during first 2020 COVID-19 outbreak. Eur J Trauma Emerg Surg. 2021;47:677-82.
Khalaf A, El-Shimy G, Osman E. Effects of COVID-19 pandemic on general surgical emergencies priorities. Al-Azhar Intern Med J. 2022;3:99-106.
Surek A, Ferahman S, Gemici E, Dural AC, Donmez T, Karabulut M. Effects of COVID-19 pandemic on general surgical emergencies: are some emergencies really urgent? Level 1 trauma center experience. Eur J Trauma Emerg Surg. 2021;47:647-52.
Carpio Colmenares YT, Cardenas Ruiz de Castilla D, Garcia Barrionuevo LA, Valencia MRL, Doria PM, Nole VM, et al. Emergency abdominal laparoscopic surgery during the coronavirus disease 2019 pandemic: Experience in a private center in Peru. J Laparoendosc Adv Surg Tech A. 2021;31:261-65.
Hessheimer AJ, Trapero-Bertran M, Borin A, Butori E, Curell A, Espinoza AS, et al. Resource utilization and outcomes in emergency general surgery during the COVID-19 pandemic: an observational cost analysis. PLoS One. 2021;16:e0252919.
An S, Kim HR, Jang S, Kim K. The impact of the coronavirus disease 2019 pandemic on the clinical characteristics and treatment of adult patients with acute appendicitis. Front Surg. 2022;9:878534.
Rajesh J, Valentelyte G, McNamara DA, Sorensen J. Impact of the COVID-19 pandemic on provision and outcomes of emergency abdominal surgery in Irish public hospitals. Ir J Med Sci. 2022;191:2275-8.
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