Emergency obstructed hernia admissions over the COVID-19 national lockdowns: a regional review.

Abstract

<h4>Introduction</h4>Emergency obstructed hernias pose a significant clinical challenge and can lead to higher complication rates, prolonged recovery, bowel resection and recurrence. Early diagnosis, urgent surgical intervention and appropriate antimicrobial prophylaxis are key. Our study aimed to describe the impact of national lockdowns on emergency obstructed hernia admissions and the effect on patient demographics and compliance with recommendation rates. Should another lockdown be in place in the future this could help us prepare plans for appropriate care and service provision.<h4>Methods</h4>Patient records for those who received emergency surgery on obstructed hernias at a single site during the three COVID-19 lockdown periods in England were reviewed and underwent thematic analysis. A temporal comparison was undertaken, and 105 patients met the inclusion criteria.<h4>Results</h4>There were no significant differences in age, American Society of Anesthesiologists (ASA) grade and length of stay. The mean duration of symptoms was 1,307 ± 1,779 days in the lockdown group vs 215 ± 593 days in the control group (<i>p</i> < 0.005). Long-standing hernias were the primary reason for admission in the lockdown group compared with 'other medical issues' in the control group. Both the 7-day (7.5% vs 4.6%; <i>p</i> < 0.05) and 30-day (10.0% vs 7.7%; <i>p</i> < 0.05) re-admission rates were higher in the lockdown group than the control group.<h4>Conclusions</h4>This study suggests that more patients presented in obstruction and as an emergency with long-standing hernias during the COVID-19 lockdown. We recommend enacting adequate postoperative follow-up to reduce higher rates of re-admission, and better patient education or discussions with primary care to ensure adequate forward referrals of hernias.