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

## TL;DR

This study found that during the COVID-19 lockdowns, more patients with long-standing hernias required emergency surgery, leading to higher re-admission rates.

## Contribution

The study highlights the impact of lockdowns on hernia management and suggests strategies to reduce re-admissions.

## Key findings

- Lockdown patients had longer symptom duration and higher re-admission rates compared to controls.
- Long-standing hernias were the main cause of emergency admissions during lockdowns.
- Re-admission rates were significantly higher in the lockdown group at 7 and 30 days post-surgery.

## Abstract

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.

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.

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 (p < 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%; p < 0.05) and 30-day (10.0% vs 7.7%; p < 0.05) re-admission rates were higher in the lockdown group than the control group.

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.