Moreover, we hypothesize that the severity of confinement measures (whether complete or partial lockdown) influences the type of emergencies that present in the SED. Taking all these factors into account, it is plausible that the pandemic has drastically changed the patient synthesis of the surgical emergency department (SED) by limiting the number of patients seeking emergent surgical advice for potentially postponable causes. Nevertheless, the level of care for patients presenting with surgical emergencies necessitating urgent or emergent surgical interventions needed to be maintained. Most authorities opted to postpone elective surgical cases when feasible in an effort to relocate resources to COVID-19 patients. Importantly, COVID-19 has posed a significant strain on hospital systems largely due to the increase of hospitalizations of patients with coronavirus-related disease. The pandemic caused a rise in healthcare demands worldwide and has necessitated significant restructuring of hospital emergency departments. Shortly after its emergence, the rapid spread of COVID-19 forced governments across the globe to implement unprecedented measures such as social distancing, avoidance of physical contact, and complete or partial confinement measures (colloquially termed as lockdown) in an effort to minimize contagion. The worldwide spread of the disease and the severe mortality and morbidity associated with it has led the World Health Organization (WHO) to declare it as a pandemic in March 2020. The new SARS-CoV-2 virus, commonly referred to as coronavirus disease 2019 (COVID-19), has been in the spotlight of the international medical community since its first appearance in December 2019. In Greece, SED attendance was significantly reduced during the pandemic, an effect that was even more pronounced during the lockdown implementation nevertheless, the overall rate of hospital admissions remained the same, denoting that patient care was not altered. The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. Overall, application of the lockdown led to a significant decrease in minor ( p<0.001) and torso ( p=0.001) injuries. An increase in the rate of fall injuries was also demonstrable ( p=0.02). During the second lockdown, there was a reduction in the number of perianal abscess cases ( p=0.04) and hernia-related problems ( p=0.001). The same effect was observed regarding the rate of hospital admissions ( p=0.002), although in terms of absolute numbers, admissions remained unchanged. Contrarily, the rate of head injuries ( p<0.001) and abdominal pain ( p=0.04) were significantly increased. During the first lockdown, there was statistically significant reduction of motor vehicle accidents ( p=0.04) and torso injuries ( p=0.01). The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2019 to 1819 in 2020). Demographic and clinical data were compared to those obtained from the same time periods of the year 2019. Since the beginning of the COVID-19 pandemic in Greece (1 March 2020) and up to 15 December 2020, the charts of all adult patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A to and period D to ) and two interim (period B to and period C to ) periods. The aim of the present study is twofold: firstly, to discern any differences in regard to reason for surgical emergency department (SED) attendance and hospital admission during the pandemic and pre-pandemic eras in Greece, and secondly, to assess the impact of the lockdown measures implemented during the pandemic on SED patient attendance. The COVID-19 pandemic caused a rise in healthcare demands leading to significant restructuring of hospital emergency departments worldwide.
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