Prioritising patients for emergency surgery or not: the impact of COVID-19 (ESORT-C19)

Many patients with common acute conditions, such as appendicitis, are admitted to hospital in an emergency. Some patents have emergency surgery, but others receive 'conservative management', which includes the possibility of later surgery. For many patients, it is unclear whether the benefits of emergency surgery are greater than the risks. Following the COVID-19 outbreak, planned surgery in the NHS was cancelled. As a result, NHS waiting lists are now approaching 10 million patients. The NHS urgently needs evidence to inform which patients should be prioritised for emergency surgery. Information for patients on the risks and outcomes of emergency surgery must recognise the impact of COVID-19. This research study will assess the effect of COVID-19 on access to emergency surgery for different patient groups, and will report on the effectiveness and cost-effectiveness of emergency surgery versus conservative management following the COVID-19 outbreak. Evidence-based recommendations, which can be quickly incorporated into NHS guidelines, will be developed on which patients should be prioritised for emergency surgery in the COVID-19 recovery phase. The project team will use Hospital Episode Statistics (HES) data on emergency admissions to NHS hospitals for acute conditions during the COVID-19 pandemic, and discussions with clinicians and patients will provide insights about the impact of the pandemic on decisions made about emergency surgery versus conservative management. The analysis will look at emergency hospital admissions for five acute conditions where there is clinical uncertainty about which patients should have emergency surgery: acute appendicitis, cholelithiasis, diverticulitis, acute (groin) hernia and intestinal bowel obstruction.