How the COVID-19 pandemic affected the severity and clinical presentation of diverticulitis.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Intestinal Research Pub Date : 2023-10-01 Epub Date: 2023-10-26 DOI:10.5217/ir.2022.00042

Sara S Soliman, Rolando H Rolandelli, Grace C Chang, Amanda K Nemecz, Zoltan H Nemeth

{"title":"How the COVID-19 pandemic affected the severity and clinical presentation of diverticulitis.","authors":"Sara S Soliman, Rolando H Rolandelli, Grace C Chang, Amanda K Nemecz, Zoltan H Nemeth","doi":"10.5217/ir.2022.00042","DOIUrl":null,"url":null,"abstract":"Background/aims: Single-institution studies showed that patients presented with more severe diverticulitis and underwent more emergency operations during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we studied this trend using nationwide data from the American College of Surgeons National Surgical Quality Improvement Program database.Methods: Patients (n = 23,383) who underwent a colectomy for diverticulitis in 2018 (control year) and 2020 (pandemic year) were selected. We compared these groups for differences in disease severity, comorbidities, perioperative factors, and complications.Results: During the pandemic, colonic operations for diverticulitis decreased by 13.14%, but the rates of emergency operations (17.31% vs. 20.04%, P< 0.001) and cases with a known abscess/perforation (50.11% vs. 54.55%, P< 0.001) increased. Likewise, the prevalence of comorbidities, such as congestive heart failure, acute renal failure, systemic inflammatory response syndrome, and septic shock, were higher during the pandemic (P< 0.05). During this same period, significantly more patients were classified under American Society of Anesthesiologists classes 3, 4, and 5, suggesting their preoperative health states were more severe and life-threatening. Correspondingly, the average operation time was longer (P< 0.001) and complications, such as organ space surgical site infection, wound disruption, pneumonia, acute renal failure, septic shock, and myocardial infarction, increased (P< 0.05) during the pandemic.Conclusions: During the pandemic, surgical volume decreased, but the clinical presentation of diverticulitis became more severe. Due to resource reallocation and possibly patient fear of seeking medical attention, diverticulitis was likely underdiagnosed, and cases that would have been elective became emergent. This underscores the importance of monitoring patients at risk for diverticulitis and intervening when criteria for surgery are met.","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626013/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intestinal Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5217/ir.2022.00042","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/10/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background/aims: Single-institution studies showed that patients presented with more severe diverticulitis and underwent more emergency operations during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we studied this trend using nationwide data from the American College of Surgeons National Surgical Quality Improvement Program database.

Methods: Patients (n = 23,383) who underwent a colectomy for diverticulitis in 2018 (control year) and 2020 (pandemic year) were selected. We compared these groups for differences in disease severity, comorbidities, perioperative factors, and complications.

Results: During the pandemic, colonic operations for diverticulitis decreased by 13.14%, but the rates of emergency operations (17.31% vs. 20.04%, P< 0.001) and cases with a known abscess/perforation (50.11% vs. 54.55%, P< 0.001) increased. Likewise, the prevalence of comorbidities, such as congestive heart failure, acute renal failure, systemic inflammatory response syndrome, and septic shock, were higher during the pandemic (P< 0.05). During this same period, significantly more patients were classified under American Society of Anesthesiologists classes 3, 4, and 5, suggesting their preoperative health states were more severe and life-threatening. Correspondingly, the average operation time was longer (P< 0.001) and complications, such as organ space surgical site infection, wound disruption, pneumonia, acute renal failure, septic shock, and myocardial infarction, increased (P< 0.05) during the pandemic.

Conclusions: During the pandemic, surgical volume decreased, but the clinical presentation of diverticulitis became more severe. Due to resource reallocation and possibly patient fear of seeking medical attention, diverticulitis was likely underdiagnosed, and cases that would have been elective became emergent. This underscores the importance of monitoring patients at risk for diverticulitis and intervening when criteria for surgery are met.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

新冠肺炎大流行如何影响膀胱炎的严重程度和临床表现。

背景/目的：单机构研究表明，在2019冠状病毒病（新冠肺炎）大流行期间，患者出现了更严重的膀胱炎，并接受了更多的紧急手术。因此，我们使用美国外科医生学会国家外科质量改进计划数据库中的全国数据研究了这一趋势。方法：选择2018年（对照年）和2020年（疫情年）因憩室炎接受结肠切除术的患者（n=23383）。我们比较了这些组在疾病严重程度、合并症、围手术期因素和并发症方面的差异。结果：在疫情期间，憩室炎的结肠手术减少了13.14%，但急诊手术率（17.31%对20.04%，P＜0.001）和已知脓肿/穿孔病例（50.11%对54.55%，P＜001）增加。同样，在疫情期间，充血性心力衰竭、急性肾功能衰竭、全身炎症反应综合征和感染性休克等合并症的患病率更高（P<0.05）。在同一时期，美国麻醉师学会将更多的患者分为3、4和5级，表明他们术前的健康状况更加严重，危及生命。相应地，在疫情期间，平均手术时间更长（P<0.001），器官间隙手术部位感染、伤口破裂、肺炎、急性肾功能衰竭、感染性休克和心肌梗死等并发症增加（P<0.05）。结论：在疫情期间，手术量减少，但憩室炎的临床表现变得更加严重。由于资源的重新分配，以及患者可能害怕寻求医疗救助，憩室炎可能诊断不足，本应是选择性的病例变得紧急。这强调了监测有憩室炎风险的患者并在符合手术标准时进行干预的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.