Impacto de la COVID-19 sobre el proceso quirúrgico de apendicitis aguda y la calidad percibida en el Hospital Clínico Universitario Virgen de la Arrixaca

Abstract

Introduction: The emergence of the COVID-19 pandemic forces health services to make structural and procedural modifications to guarantee an adequate and safe response to the population's health problems. The emergency services, therefore, establish 2 different and separate healthcare circuits (COVID-19 and not COVID-19) and urgent surgical processes establish a biosafety protocol that involves performing a pre-surgical PCR. Given this, we consider how these modifications could influence the surgical process of acute appendicitis. Objectives: The purpose of this work is to study the impact that the COVID-19 pandemic generates on the urgent surgical process and the perceived quality of the patient with acute appendicitis. We propose the following objectives: • Find out if the application of the pre-surgical biosafety protocol, which includes the performance of COVID-19 PCR, modifies the length of stay in the emergency room of patients with acute appendicitis compared to the pre-pandemic period and the 3 pandemic phases. • Analyze if there are changes in the evolutionary degree of acute appendicitis in the different phases of the COVID-19 pandemic and the pre-pandemic period. • Evaluate the complications of the acute appendicitis surgical process in the different phases of the pandemic with respect to the pre-pandemic period. • Analyze the perceived quality of patients operated on for acute appendicitis in the pre-pandemic and pandemic period. Patients and method: Observational, descriptive, retrospective and single-center cross-sectional study consisting of two parts: in the first, the computerized medical records of patients operated on for acute appendicitis are reviewed, and in the second, a telephone survey is carried out on the perceived quality of care. The group of patients studied are older than 14 years, treated in the emergency department of the HCUVA, who require urgent intervention for acute appendicitis in the HCUVA during the period from March to November 2019 (pre-pandemic period) and the same period of 2020 (pandemic period). Results: 330 patients who underwent appendectomy were included: 153 in the pandemic period and 177 in the pre-pandemic period, with similar demographic characteristics in both groups. Pre-surgical stay times are similar in pre-pandemic (11.2 hours vs 11.9 hours in pandemic). The mean surgical time in the pandemic period (64.5 minutes) is significantly shorter than that observed in the pre-pandemic period (80.6 minutes). The evolutionary degrees do not present significant statistical differences, the first value corresponds to pre-pandemic and the second to pandemic: edematous 16.4% vs 18.5%, phlegmonous 53.7% vs 48.3%, gangrenous 18.1% vs 21,2% and perforated 2.8% vs 6%. The percentage of patients hospitalized for just one day increased in the pandemic period (88.2%) compared to the pre-pandemic period (78%). Post-surgical complications do not suffer a significant increase, they are 7.4% pre-pandemic vs 10.5% pandemic. Regarding the perceived quality, in the 3 phases studied, we observed that the values remain high without significant changes when comparing the pre-pandemic period with respect to the pandemic period: emergency care (8.84 vs 8.59), surgical care (9.14 vs. 9.05) and information upon discharge (9.03 vs. 8.64). Conclusions: The protocols and circuits established in the COVID-19 pandemic have been effective to detect and avoid contagion, both in non-COVID-19 patients and professionals, the incorporation of the COVID-19 PCR did not affect the time of pre-surgical stay in hospital emergency department. In the pandemic period studied, we observed a decrease in surgical time and hospital stay in the process of acute appendicitis, without showing differences in its evolutionary degree. Likewise, the quality perceived by the patients in the phases studied is high and there are no changes compared to the pre-pandemic period.