ThTP8.13 The international PIACO study: pattern of surgical approaches for acute surgical pathologies in Spain versus UK. Was conservative treatment and open surgery during COVID-19 the way to go?

Abstract

A multicentre, comparative, international study was conducted in 16 centres in Spain and four in the UK, aiming to assess the impact of the COVID-19 pandemic and associated public health measures, on presentation and management of acute surgical pathologies.

Overall, 2181 cases were analysed (Table 1). A significantly lower percentage of mild cases of appendicitis presented during the pandemic in Spain and the UK, compared with the same time interval a year before (2020, 466 (57.7 per cent); 2019, 882 (65.2 per cent), P < 0.001. Surgery was less frequently employed during the pandemic (509 (62.3 per cent) versus 921 (68 per cent), P = 0.007). When it was employed, it was significantly less frequently laparoscopic (251 (70.1 per cent) versus 622 (90.8 per cent), P < 0.001).

The independent predictors of non-surgical treatment of appendicitis and cholecystitis were presenting in the UK (appendicitis OR0.026, P < 0.001; cholecystitis, OR0.148, P=0.031), non-severe condition at diagnosis (appendicitis OR 11.433, P = 0.036; cholecystitis OR7.944, P=0.022) and a COVID-19-positive diagnosis (OR 0.142, P < 0.001). Predictors for open surgery were presenting in the UK (OR 0.152, P < 0.001) and COVID-19-positive status (OR 0.112, P = 0.002). There were no differences in mortality between the two years. Severity at diagnosis was the only independent predicting factor for major complications (OR 3.148, P = 0.003).

This study demonstrates a shift towards conservative treatment and open surgery during the first wave of the COVID-19 pandemic. Surgical treatment did not correlate with higher complication rates; indicating that surgical treatment may have been as safe as conservative treatment during COVID-19.