key: cord-275503-rxjilkff
authors: Ponkilainen, Ville; Kuitunen, Ilari; Hevonkorpi, Teemu P.; Paloneva, Juha; Reito, Aleksi; Launonen, Antti P.; Mattila, Ville M.
title: The effect of nationwide lockdown and societal restrictions due to COVID‐19 on emergency and urgent surgeries
date: 2020-08-07
journal: Br J Surg
DOI: 10.1002/bjs.11847
sha: 
doc_id: 275503
cord_uid: rxjilkff

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Due to COVID-19 pandemic, surgical societies have recommended to postpone elective and non-urgent surgeries [1] [2] [3] . Pandemic potentially prevents patients from seeking medical care also due to acute illnesses. To date, no studies have been conducted on how the pandemic, the resultant social restrictions, and the cancelling of elective operations in hospitals has affected the rate of emergency surgeries.

The data for this retrospective study was collected from three Finnish The weekly mean incidence of emergency and urgent surgery remained stable after the announcement of the national lockdown (Fig. 1A) . However, the weekly mean average was 16 per cent (5 operations per day) less than the average during the previous four years. The incidence of patients aged less than and over 70 years followed a similar trend (Fig. 1B) .

The number of the most common operation, laparoscopic appendicectomy, decreased by 32 per cent (from 75 to 51, p = 0⋅03) three weeks before the lockdown. However, between three to six weeks after the lockdown, the number rebounded 23 per cent (57 to 70, p = 0⋅25) towards its previous level. The number of hip fracture operations decreased slightly in both the hemi endoprosthesis group (37 per cent, p = 0⋅12, 0-3 weeks after) and the intramedullary nail group (35 per cent, p = 0⋅17, 3-0 weeks before). However, the decrease was followed by a notable rebound (64 per cent, p = 0⋅01) from 37 to 61 operations per three weeks.

General mobility in the catchment areas of the participating hospitals decreased notably one week before the declaration of national lockdown.

The total incidence of emergency and urgent surgeries was already lower before the lockdown than during the previous four years, and it remained stable during the lockdown. A notable rebound in the rate of appendicectomies and hip fracture operations was seenthree weeks after the lockdown started. The decreasing appendicectomy rate may be the result of citizens avoiding unnecessary healthcare visits, and have therefore delayed their first contact with the ED. Conversely, a decreasing trend among hip surgery may be due to senior citizens obeying the general recommendations to stay at home and to avoid falling on slippery roads outside. The general mobility of the population measured by the amount of traffic on the main roads did not result in a decreased rate in emergency or urgent surgery.

Guidelines for ambulatory surgery centers for the care of surgically necessary/time-sensitive orthopaedic cases during the COVID-19 pandemic

Global guidance for surgical care during the COVID-19 pandemic

Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans