Long term Implications in Surgical re-Assisting (L.I.S.A. study) during the Covid-19 outbreak. A retrospective observational cohort study on a rural population

Background: COVID-19 is having a worldwide impact on surgical treatment. Our aim was to investigate the impact of the pandemic in a rural hospital serving a low densely populated area. Methods: We investigated the volume and type of surgical performed operations during both the pandemic (March 2020 - February 2021) and pre-pandemic periods (March 2019 - February 2020) as well as during the first and second pandemic waves compared to the pre-pandemic period. We compared the volume and timing of emergency appendectomy and cholecystectomy performed during the pandemic with those of the pre-pandemic period, doing the same with the volume, timing and stages of elective gastric and colorectal resections for cancer. Results: In the pre-pandemic period a higher number of appendectomies (42 vs. 24) and urgent and elective cholecystectomies (174 vs. 126) was performed. The patients operated during the pandemic period (both for appendectomy and cholecystectomy) were on average older (58 vs. 52 years old, p=0.006), including for cholecystectomy (73 vs. 66 years old, p=0.01) and appendectomy (43 vs. 30 years old, p =0.04). The logistic regression analysis with regard to the cholecystectomies and appendectomies performed in emergency showed that male sex and age were associated with gangrenous type histology, both in the pandemic and pre-pandemic period. Finally, we found a reduction in the stage I and IIA colorectal cancers operated during the pandemic compared to those of the pre-pandemic period, with no increase of the advanced stages. Conclusions: The reduction in services imposed by governments during the first months of total lock down could not justify the whole decrease in surgical interventions in the year of the pandemic. Data suggest that greater "non-operative management" for appendicitis and acute cholecystitis does not lead to an increase of cases operated over time, nor to an increase in the "gangrenous" pattern, this seems to depend on age advanced and male population. Key words: COVID-19, Emergency Surgery, General Surgery, Pandemics.