Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID-19 pandemic
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LETTER TO THE EDITOR
Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID‑19 pandemic D. L. Lima1 · X. Pereira2 · D. C. dos Santos3 · D. Camacho4 · F. Malcher5 Received: 23 May 2020 / Accepted: 10 June 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
As our hospitals become overwhelmed with the COVID19 pandemic, our ability to provide timely and safe emergency surgical care has been called into question [1] In our hospital, located at the Bronx, NY, in which is located in one of the most affected zip codes in the country, our surgical department was largely re-deployed to non-surgical services to help our overburdened medicine colleagues. Nonetheless, our surgeons remained committed to providing adequate emergency surgical care. Surprisingly, we experienced a decrease in the number of patients presenting with emergency surgical ailments, especially those presenting with incarcerated hernias. This paradoxical effect has been described by other authors and largely attributed to the concept of competing risk, patient apprehension, and secondary effects of an overburdened system [1, 2]. At our institution, the first COVID-19 case was admitted on March 11th, 2020. Elective surgeries completely ceased on March 18th, and the peak number of COVID-19 positive patients diagnosed in a day came on April 14, 2020. The total number of emergency cases at the peak of the epidemic, between March 11th and May 10th, was 209, which represents a 48% reduction in volume when compared to 401 during the same period of 2019. Looking solely at abdominal wall repairs during this period, we had four emergency cases: two incarcerated inguinal and two ventral hernias (a strangulated umbilical * D. L. Lima [email protected] 1
Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
2
Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
3
Pernambuco Health College, Recife, Brazil
4
Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
5
Abdominal Wall Program, Department of Surgery, Montefiore Medical Center and Assistant Professor, Albert Einstein College of Medicine, Bronx, NY, USA
hernia with bowel resection and one incisional hernia). During the same period in 2019, we had 18 emergency hernia cases; 7 inguinal and 11 ventral repairs, 2 of which incisional hernias. At our hospital, we have a dedicated abdominal wall program that performs roughly 1500 hernia repairs annually. Thus, when elective procedures were cancelled, we expected an increased number of hernia-related surgical emergencies. Yet, we experienced the opposite. The proportion of emergency to elective hernia surgeries in 2020 was significantly lower when compared to the same period of 2019 (1.9% vs 4.9%, p = 0.03). Following a similar trend, consultations for hernia-related pathologies decreased by 66% during the pandemic. In recent years, multiple authors have proposed early repair of inguinal hernia to prevent complications such as stra
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