RT Journal Article
SR Electronic
T1 Emergency general surgery utilization and disparities during COVID-19: an interrupted time-series analysis
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000679
DO 10.1136/tsaco-2021-000679
VO 6
IS 1
A1 Anya L Greenberg
A1 Hope Schwartz
A1 Caitlin R Collins
A1 Yvonne M Kelly
A1 Robert Mackersie
A1 Michelle Mourad
A1 John P Roberts
A1 Tasce Bongiovanni
YR 2021
UL http://tsaco.bmj.com/content/6/1/e000679.abstract
AB Objective We aimed to compare general surgery emergency (GSE) volume, demographics and disease severity before and during COVID-19.Background Presentations to the emergency department (ED) for GSEs fell during the early COVID-19 pandemic. Barriers to accessing care may be heightened, especially for vulnerable populations, and patients delaying care raises public health concerns.Methods We included adult patients with ED presentations for potential GSEs at a single quaternary-care hospital from January 2018 to August 2020. To compare GSE volumes in total and by subgroup, an interrupted time-series analysis was performed using the March shelter-in-place order as the start of the COVID-19 period. Bivariate analysis was used to compare demographics and disease severity.Results 3255 patients (28/week) presented with potential GSEs before COVID-19, while 546 (23/week) presented during COVID-19. When shelter-in-place started, presentations fell by 8.7/week (31%) from the previous week (p<0.001), driven by decreases in peritonitis (β=−2.76, p=0.017) and gallbladder disease (β=−2.91, p=0.016). During COVID-19, patients were younger (54 vs 57, p=0.001), more often privately insured (44% vs 38%, p=0.044), and fewer required interpreters (12% vs 15%, p<0.001). Fewer patients presented with sepsis during the pandemic (15% vs 20%, p=0.009) and the average severity of illness decreased (p<0.001). Length of stay was shorter during the COVID-19 period (3.91 vs 5.50 days, p<0.001).Conclusions GSE volumes and severity fell during the pandemic. Patients presenting during the pandemic were less likely to be elderly, publicly insured and have limited English proficiency, potentially exacerbating underlying health disparities and highlighting the need to improve care access for these patients.Level of evidence III.