M. Harrison1, H. Carmichael1, D. Abbitt1, M. Thomas1, A. N. Moore1, Q. W. Myers1, C. G. Velopulos1 1University Of Colorado Denver, Surgery, Aurora, CO, USA
Introduction: The COVID-19 pandemic has impacted not only directly infected individuals, but has directly impacted the delivery of emergency general surgery (EGS) and contributed to widespread bed shortages for both COVID-19 and non-COVID-19 patients. At our institution, a level 1 trauma center and tertiary referral center, rapid testing is not routinely approved for our EGS patients. We examined two common EGS conditions (appendicitis and acute cholecystitis) to observe this impact, hypothesizing that the necessity of testing for COVID, without offering rapid testing, delayed operative intervention significantly, contributing to need for admission during a time of hospital bed shortage.
Methods: We performed a pre-post study examining a 3 month time period prior to COVID-19 testing (1/1/2020-3/1/2020) as a historical control, with a 3 month time period during the COVID era (1/1/2021-3/1/2021). We chose conditions that are typically surgically treated at our institution as outpatient/observation status. Exclusion criteria included initial decision for non-operative management and medical conditions requiring optimization/admission prior to surgery. We examined time for COVID test to result, and associated time to OR and need for admission.
Results: Median time to COVID-19 test result was 7.4 hours [5.8, 13.1]. For appendectomy, time to surgery consultation did not differ between the groups (2.3 [1.7, 3.0] vs. 2.5 [1.0, 2.9] hours), neither did time to case request nor time to discharge after the OR (Table). Time to OR after case request and admission was several hours longer, all attributable to time waiting for COVID-19 test results. Importantly, more than 65% of patients were treated without admission in the pre-COVID-19 era, compared to less than 15% treated without admission during COVID-19 era. Similarly, for cholecystectomy time to OR after case request was 9.0 [4.2, 19.6] vs. 21.1 [15.3, 25.0], p=<0.001, and time from admission to OR was 14.4 [8.3, 23.9] vs. 25.0 [19.9, 29.3], p=0.001.
Conclusion: While COVID-19 positivity rate remains high, routine testing remains necessary since COVID-19 positivity is associated with worse outcomes, and the decision for surgery is potentially affected by the results. Waiting for results directly impacts time to surgery, as well as the need for admission for historically outpatient procedures during a time of increasing bed shortages. Rapid testing should be routine for patients with EGS conditions.
