EGS P23 Boerhaave syndrome: provision of emergency services during the COVID era

Abstract Background The provision of emergency surgery was significantly impacted during the COVID-19 pandemic. This was due to limited intensive care beds and the risk of catching COVID-19 in the post-operative period. The aim of this study was to determine whether outcomes for patients with Boerhaave syndrome were negatively affected by service constraints during the COVID-19 pandemic. Methods Single centre case control study of patients with Boerhaave syndrome before and during the COVID pandemic. Univariate and multivariate analyses was employed to determine whether patient outcomes following Boerhaave syndrome were influenced by the COVID pandemic (defined here as 2020–2022) compared to a pre-pandemic period (2013–2019). Results During the COVID pandemic, 7 patients presented with Boerhaave syndrome, although none of these patients tested positively for COVID-19. Patient characteristics and outcome data of these patients were compared to a group of 14 patients with Boerhaave syndrome during a pre-pandemic period. The median age of patients presenting with Boerhaave syndrome was statistically significantly lower during the pandemic compared to those presenting before the pandemic (28 years versus 60 years, p=0.04). There was no significant difference in the treatment approach between the two groups, with non-operative and operative measures being employed in both groups equally (p=0.66), suggesting that the pandemic did not influence treatment decision. There was no difference in the use of endoscopic stenting between the groups (p=0.25). 30-day mortality was equal between patients admitted during the pandemic and those admitted before the pandemic (p=0.13). Conclusions This study demonstrated that the median age of patients presenting with Boerhaave syndrome during the pandemic was significantly lower than it was historically. This may have reflected shifts in behaviour and lifestyle during the pandemic. Never-the-less, the impact on services during the pandemic did not appear to influence treatment choice, and 30-day mortality remained the same for both patient groups. This may have reflected provision of COVID-secure pathways and locations.