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Vol. 99. Issue 9.
Pages 660-665 (November 2021)
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Vol. 99. Issue 9.
Pages 660-665 (November 2021)
Original article
Proctologic emergency consultation during COVID-19: Comparative cross-sectional cohort study
Proctología urgente en tiempos de COVID-19: estudio comparativo de cohortes ¿cómo justificar este cambio?
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Rocío Maqueda Gonzaleza,
Corresponding author
rmaquedagonzalez@gmail.com

Corresponding author.
, Carlos Cerdán Santacruza, Javier García Septiema, Lara Blanco Terésa, Jose María Lopesino Gonzáleza, Guillermo Fernández Jiménezb, Elena Martín-Péreza
a Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
b Unidad de Información Clínico-Asistencial, Servicio de Admisión y Documentación Clínica, Hospital Universitario La Princesa, Madrid, Spain
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Tables (2)
Table 1. Demographic and relevant comorbidities in the whole sample and in each year of study period.
Table 2. Details of emergency department proctologic consultations during the pandemic and the previous historic cohort. Main complaint, definitive diagnosis, required treatment and change in standard of care are shown.
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Abstract
Introduction

Proctologic issues entail a frequent reason for consultation in the emergency department (ED). We aim to analyze how the SARS-COV-2 pandemic has impacted in the demand for proctological consultations.

Material and method

Descriptive comparative retrospective study of cross-sectional cohorts of patients attending the ED for proctological complaints from March to April in 2020 and 2019. Demographic variables, comorbidities, reasons for consultation and diagnosis, treatment and readmission were included. Four periods were analyzed according to the different stages of the pandemic derived limitations.

Results

A total of 191 patients were reviewed, 58 in 2020 and 133 in 2019 with an average age of 48 years (SD 20.1) and 112 (58.6%) males. The average number of daily consultations was 2.18 patients in 2019 versus 0.95 in 2020 (p=0.025) meaning a 56% reduction in consultations for proctological reasons. This difference in average consultations was significant in both periods of lockout (p=0.001) and previous de-escalation (p=0.014). The diagnosis distribution was similar between both periods; however, perianal abscesses doubled their rate in 2020, 22.4% versus 11.3% (p=0.045). There was an increasing need for surgery, 31% vs 15% (p=0.011) with no difference in outpatients regimen after emergency surgery (12.5% vs 7.5%, p=0.201). Three patients in 2020 required readmission to the ED (5.2% vs 12.9%, p=0.086).

Conclusion

There was a decrease of a 56% in proctologic emergency consultation, however, the need for surgery was twice more frequent during the study period. Reflection on the use of emergencies for proctological reasons is warranted.

Keywords:
Anorectal
Emergencies
Proctological consultation
SARS-CoV-2
COVID-19
Resumen
Introducción

La enfermedad proctológica supone un motivo de consulta frecuente en los servicios de urgencia. Nuestro objetivo es analizar como la pandemia por SARS-CoV-2 ha impactado en la demanda de consultas proctológicas.

Material y método

Estudio comparativo retrospectivo de cohortes transversales en el periodo de marzo y abril de 2020 y 2019 de las consultas urgentes por motivos proctológicos. Se incluyeron variables demográficas, antecedentes, motivo de consulta y diagnóstico, tratamiento y readmisión. Se analizaron 4 periodos en función de las distintas etapas del estado de alarma.

Resultados

Se atendieron 191 pacientes, 58 en 2020 y 133 en 2019, con una edad media de 48 años, siendo 112 (58,6%) varones. La media de consultas diarias fue de 2,18 pacientes en 2019 frente a 0,95 en 2020 (p=0,025) suponiendo una reducción del 56%. Esta diferencia fue significativa en ambos periodos de confinamiento (p=0,001) y en la desescalada (p=0,014). La distribución de los motivos de consulta fue similar, sin embargo, los abscesos perianales duplicaron su tasa en 2020, 22,4 frente al 11,3% (p=0,045). Se observó un incremento de la necesidad de cirugía, 31 frente al 15% (p=0,011) sin diferencias en el manejo ambulatorio tras cirugía urgente (12,5 frente al 7,5%; p=0,201). Hubo 3 pacientes en 2020 que requirieron readmisión en urgencias (5,2 frente al 12,9%; p=0,086).

Conclusiones

El número de consultas por enfermedad proctológica urgente ha sufrido una reducción del 56%, sin embargo, las enfermedades que requieren tratamiento quirúrgico se han duplicado en proporción. La reflexión sobre el uso de urgencias por motivos proctológicos es necesaria.

Palabras clave:
Urgencias proctológicas
Consulta proctológica
SARS-CoV-2
COVID-19
Coronavirus

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