SP4.1.3 The effect of the Covid-19 pandemic on case selection and perioperative outcomes of emergency laparotomies: a UK-based multicentre cohort study

Aims Evaluating the effect of Covid-19 on case selection and perioperative outcomes of emergency laparotomies across South West London (SWL). Methods A retrospective cohort study including all emergency laparotomies performed at three SWL-based NHS hospitals from 01/04/2020-31/12/2020 (i.e., “pandemic” cohort; from the first national lockdown), versus a “pre-pandemic” cohort (01/04/2019-31/12/2019). Data was extracted from the NELA database and hospital records, and analysed by two independent clinicians. Results 414 patients met the inclusion criteria. 17.6% fewer (227 vs. 187) laparotomies were performed during the pandemic period. There were no significant sociodemographic differences between cohorts (mean age 64.5 vs. 62.7 years, p = 0.284; M:F ratio 1:1.154 vs. 1:0.928, p = 0.221). Pre-operative NELA risk scores were higher before the pandemic (mean 13.05% vs. 9.55%, p = 0.020). The commonest indication for laparotomy in both cohorts was small bowel obstruction (32.6% vs. 37.4%), treated most commonly with adhesiolysis. Postoperatively, fewer patients received HDU/ITU care during the pandemic than before (ward-based recovery 4.7% vs. 13.8%, HDU/ITU recovery 93.4% vs. 79.4%, χ2=15.4, p < 0.005). Mean duration of ITU stay was significantly shorter during the pandemic (4.5 vs. 2.7 days, p < 0.005), as was total length of inpatient stay (20.2 vs. 14.3 days, p = 0.0156). Conclusions The overall reduction in emergency laparotomies observed during the pandemic period was potentially secondary to tighter case selection guided by objective risk stratification. Fewer patients were recovered postoperatively on HDU/ITU, and patients were generally discharged from hospital earlier. Such trends in perioperative care served to support organizational prioritization in response to Covid-19 service provision.