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Emergency hernia surgery during COVID-19 outbreak: delayed presentations, more resections

The outbreak of COVID-19 pandemic has, without a doubt, affected the provision of emergency and elective surgery on a worldwide scale. In contrast to elective procedures, emergency surgery can hardly be postponed due to the associated increased morbidity and mortality risks; hence the public has been globally encouraged to seek medical attention upon the development of acute symptoms (1,2). However, in our anecdotal experience, and being in accordance to recently published data, there has been a drop in the volume of the emergency hospital admissions, with a notable increase of the complexity of the presenting problems (3). With respect to surgery, and in particular emergency hernia surgery, we have noticed a trend of delayed admission from the onset of symptoms, along with an increased percentage of non-salvageable visceral contents during emergency hernia repairs. We have therefore reviewed our operative records of emergency hernia repairs since the onset of the pandemic in our catchment area (Warwickshire, United Kingdom) between 03/2020-02/2021 (COVID-19 pandemic year) and compared them with the relevant data from 03/2019-02/2020 (pre-COVID-19 pandemic year). Of note, our hospital (district general) has been providing continuously uninterrupted emergency general surgery services in our region during the COVID-19 pandemic outbreak. However, between 03-05/2020 and 01-02/2021 there was a substantial reduction in the volume of elective operations (including hernias), with prioritization of clinically urgent cases, such as surgical oncology operations, as sole elective procedures, due to increased hospital pressures from the pandemic.