key: cord-1008132-2bz8dnyf
authors: Collard, Maxime K.; Lefèvre, Jérémie H.; Batteux, François; Parc, Yann
title: COVID‐19 heath crisis: less colorectal resections and yet no more peritonitis or bowel obstruction as a collateral effect?
date: 2020-06-16
journal: Colorectal Dis
DOI: 10.1111/codi.15199
sha: e37eb4ba6d278d713706e24c6ef369a58a5641d4
doc_id: 1008132
cord_uid: 2bz8dnyf

Because of the rapid worldwide propagation of COVID‐19 (coronavirus disease 2019), each health care system had to urgently adapt with all efforts aimed to maximize the capacity of treatment for infected patients. With this in mind, the President of the French Republic declared on March 12, 2020: “Non‐essential hospital care will be postponed, i.e. surgical procedures that are not urgent.” But, in spite of the effort deployed by each hospital to provide a sufficient capacity of treatment for patients requiring a surgical procedure as an emergency, we have observed that the management of these patients have been largely affected, not because of a lack of resources but because of a surprising lack of patients.

management of these patients have been largely affected, not because of a lack of resources but because of a surprising lack of patients. Consequently we analyzed the surgical activity from 12/03/2020 to 29/04/2020 in 16 adult gastrointestinal surgery departments within 14 French public university hospitals located in Paris or its close suburbs. The first day of this period corresponded to the date of the President's request to postpone planned surgery. The surgical procedures performed during this period were compared to those performed in 2019 over the equivalent period (14/03/2019-01/05/2019) and in the same surgical departments.

In 2019, 4,678 surgical procedures were carried out vs. 1,847 procedures in 2020 indicating an overall reduction of 61%. Planned surgical activity was reduced, as expected, from 3,013 procedures to 987 procedures (67%) with a diminution of 53% for the planned colorectal surgery (table 1). A major reduction was observed for procedures involving restoration of bowel integrity (61%). More surprisingly, emergency surgical procedures decreased by 48% (1,665 procedures vs. 860). Major surgical emergencies such as those patients presenting with peritonitis/intraabdominal abscess or bowel obstruction, ischemia or perforation also showed an unexpected decline from 56% to 46%.

The observed 61% reduction in scheduled surgery is very close to recent worldwide estimations predicting a 72% decrease in planned surgery which represents 28,404,603 operations. [1] But in parallel with this expected finding, emergency surgery was globally reduced by half during the COVID-19 health crisis in 14 French university hospitals. There are several possible causes which might explain this observation, for example the transfer of surgical emergencies to other care centers in particular to the private system, a decrease in road accidents resulting in fewer polytrauma patients requiring surgery or the adoption of non-surgical treatments of some surgical emergencies such as antibiotic therapy alone to treat uncomplicated acute appendicitis. [2] All these possible causes are, a priori, of no consequences for the patients but the observed decrease of surgical emergencies does not seem to be fully explained by these causes and it is highly

This article is protected by copyright. All rights reserved probable that the fear of patients to enter hospital has played a role. [3] This observation, which has also been reported in other serious emergencies, such as myocardial infarction [4] or stroke [5] , will have to be considered in the event of a future health crisis in order to prevent avoidable mortality. The impact of the crisis for colorectal cancer prognosis is still unknown and further studies with longer follow-up are mandatory. 

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This article is protected by copyright. All rights reserved 

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