An invited commentary on “Acute care surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study”

We read with great interest the paper “Acute Care Surgery during the COVID-19 pandemic (declared 11 March 2020) in Spain: changes in volume, causes and complications. A multicentre retrospective cohort study” by Valderrama et al. [1]. The world has undergone drastic change due to the COVID-19 pandemic. This study identifies a number of significant issues of great interest to the surgical community and focuses on effects of the pandemic on the practice of acute care surgery. The study was conducted at three tertiary care facilities in Spain in March/April of 2020. There are two groups, a control group (March 11- April 21, N = 285) and a pandemic group (March 16- April 26, N = 117).

The authors present important observations, perhaps of even greater interest because they are from Spain soon after the onset of the pandemic. The impact of COVID-19 on mortality is obviously of interest. Valderrama et al. found no significant increase in mortality after the pandemic started [1]. In a large multicenter study of 1128 patients with confirmed COVID-19 infections, another group found significantly higher mortality in these patients [2]. It is noteworthy that 51.2% of these patients had pulmonary complications. Morbidity rates did increase significantly during the pandemic in the Valderrama study [1] although the difference was not significant in a multi-variate analysis.

Overall the authors report fewer operations taking place during the pandemic period [1]. There were significantly fewer operations performed during the pandemic for acute cholecystitis and complications from previous elective surgery while the rates for other procedures were similar in both groups. The authors propose that a change in lifestyle may have reduced the number of patients with biliary diseases. Patients who presented during the pandemic period had significantly longer delays (71.0h) in presenting to the Emergency Department than those in the control period (44.6h) [1].

The pandemic will continue to have variable effects on the health care system and surgeons need guidance as the situation evolves. One source of information is from the American College of Surgeons, which has a wealth of information on its website [3]. The performance of elective surgery is dependent on the conditions of the pandemic in many hospitals. Guidelines for the resumption of elective surgery are provided and require that there is a sustained reduction in the rate of new COVID-19 cases in the geographic area. Management of elective surgery cases in the era of the pandemic are covered in great detail with a systemwide tiered approach [4]. Valderrama et al. showed the effect of the pandemic on elective surgery [1] and as the pandemic changes, hospitals must adapt to the situation.

The surgical community must remain flexible and understand the effects of the pandemic on surgical practice within the healthcare system to guide future decision-making. This will best be accomplished based on data, and the study by Valderrama et al. provides an important perspective on the effects of the pandemic on surgical practice.

“Provenance and peer review Invited Commentary, internally reviewed”