{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T02:51:55Z","timestamp":1786589515983,"version":"build-2736575974"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>This study aimed to observe the impact of the COVID-19 outbreak on acute general surgery in the first German \u201chotspot\u201d regions of Heinsberg and Aachen, during the first months of the pandemic. The incidence and severity of acute appendicitis, acute cholecystitis and mechanical bowel obstruction, were compared between March and May 2020 and a control period (same months of the previous three years). Pre-, intra- and postoperative data was compared between three regional hospitals of Heinsberg and the closest maximum care, university hospital. A total of 592 operated patients were included, 141 belonging to the pandemic cohort and 451 to the historic cohort. The pandemic group showed higher rates of clinical peritonitis (38% vs. 27%, p = 0.015), higher rates of mean white blood cell count (13.2\u00b14.4 \/nl vs. 12.3\u00b14.7 \/nl, p = 0.044) and mean C-reactive protein (60.3\u00b181.1 mg\/l vs. 44.4\u00b172.6 mg\/l, p = 0.015) preoperatively. Specifically in patients with acute appendicitis, there were less patients with catarrhal appendicitis (23% vs. 35%, p = 0.021) and a tendency towards more advanced histological findings in the pandemic cohort. In the university hospital, a 42% reduction in acute operated cases was observed at the onset of the pandemic (n = 30 in 2020 vs. n = 52 in 2019), whereas in the peripheral hospitals of Heinsberg there was only a 10% reduction (n = 111 in 2020 vs. n = 123 in 2019). The onset of the COVID-19 pandemic in our region was accompanied by advanced preoperative and intraoperative findings in patients undergoing emergency general surgery. A greater reduction in acute operated surgical cases was observed at the university hospital, in contrast to the smaller hospitals of Heinsberg, suggesting a possible shift of emergency patients, requiring immediate operation, from maximum care hospital to the periphery.<\/jats:p>","DOI":"10.1371\/journal.pone.0280867","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T18:33:00Z","timestamp":1674671580000},"page":"e0280867","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["The impact of the COVID-19 outbreak on emergency general surgery in the first German \u201chotspot region\u201d Aachen-Heinsberg\u2013A multicentre retrospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3088-1171","authenticated-orcid":true,"given":"Alexandros","family":"Chrysos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5138-4214","authenticated-orcid":true,"given":"Iakovos","family":"Amygdalos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscila","family":"Nunes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guenter","family":"Haselow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Lioupis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Rosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman Marius","family":"Eickhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Wiltberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf Peter","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Lambertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"issue":"7798","key":"pone.0280867.ref001","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/s41586-020-2008-3","article-title":"A new coronavirus associated with human respiratory disease in China","volume":"579","author":"F Wu","year":"2020","journal-title":"Nature"},{"issue":"7803","key":"pone.0280867.ref002","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1038\/s41586-020-2202-3","article-title":"Author Correction: A new coronavirus associated with human respiratory disease in China","volume":"580","author":"F Wu","year":"2020","journal-title":"Nature"},{"issue":"10223","key":"pone.0280867.ref003","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"issue":"10223","key":"pone.0280867.ref004","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S0140-6736(20)30323-8","article-title":"Department of Error","volume":"395","year":"2020","journal-title":"Lancet"},{"issue":"9","key":"pone.0280867.ref005","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2020.25.9.2000178","article-title":"First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020","volume":"25","author":"G Spiteri","year":"2020","journal-title":"Euro Surveill"},{"issue":"10","key":"pone.0280867.ref006","first-page":"665","article-title":"Coronavirus (SARS-CoV-2)\u2014Outbreak in North Rhine-Westphalia (District of Heinsberg)\u2014First diagnosis of a COVID-19 manifestation in a couple","volume":"145","author":"J Laufs","year":"2020","journal-title":"Dtsch Med Wochenschr"},{"issue":"6","key":"pone.0280867.ref007","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1097\/TA.0000000000002923","article-title":"Dramatic decrease of surgical emergencies during COVID-19 outbreak","volume":"89","author":"S Rausei","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"pone.0280867.ref008","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s13304-020-00779-6","article-title":"What happened to surgical emergencies in the era of COVID-19 outbreak? Considerations of surgeons working in an Italian COVID-19 red zone","volume":"72","author":"A Patriti","year":"2020","journal-title":"Updates Surg"},{"issue":"6","key":"pone.0280867.ref009","doi-asserted-by":"crossref","first-page":"e160480","DOI":"10.1001\/jamasurg.2016.0480","article-title":"Use of National Burden to Define Operative Emergency General Surgery","volume":"151","author":"JW Scott","year":"2016","journal-title":"JAMA Surg"},{"issue":"19","key":"pone.0280867.ref010","doi-asserted-by":"crossref","first-page":"362","DOI":"10.21037\/atm.2016.09.10","article-title":"Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases","volume":"4","author":"G Cervellin","year":"2016","journal-title":"Ann Transl Med"},{"key":"pone.0280867.ref011","unstructured":"ICD and OPS code search. Available from: https:\/\/gesund.bund.de\/en\/icd-ops-code-search."},{"issue":"10","key":"pone.0280867.ref012","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"E von Elm","year":"2007","journal-title":"PLoS Med"},{"issue":"2","key":"pone.0280867.ref013","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"PA Clavien","year":"2009","journal-title":"Ann Surg"},{"issue":"1","key":"pone.0280867.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0b013e318296c732","article-title":"The comprehensive complication index: a novel continuous scale to measure surgical morbidity","volume":"258","author":"K Slankamenac","year":"2013","journal-title":"Ann Surg"},{"key":"pone.0280867.ref015","unstructured":"Germany, F.M.o.H.o (2020) 2020. Available from: https:\/\/www.bundesgesundheitsministerium.de\/coronavirus\/chronik-coronavirus.html."},{"issue":"7","key":"pone.0280867.ref016","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1002\/bjs.11627","article-title":"COVID-19 pandemic: perspectives on an unfolding crisis","volume":"107","author":"A Spinelli","year":"2020","journal-title":"Br J Surg"},{"issue":"6","key":"pone.0280867.ref017","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1097\/TA.0000000000002695","article-title":"COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community","volume":"88","author":"H Kurihara","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"pone.0280867.ref018","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1097\/SLA.0000000000003924","article-title":"Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy","volume":"272","author":"MH Zheng","year":"2020","journal-title":"Ann Surg"},{"key":"pone.0280867.ref019","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.ijsu.2020.05.022","article-title":"Impact of the Coronavirus (COVID-19) pandemic on surgical practice\u2014Part 1","volume":"79","author":"A Al-Jabir","year":"2020","journal-title":"Int J Surg"},{"issue":"3","key":"pone.0280867.ref020","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s00423-020-01888-x","article-title":"Surgery in times of COVID-19-recommendations for hospital and patient management","volume":"405","author":"S Flemming","year":"2020","journal-title":"Langenbecks Arch Surg"},{"key":"pone.0280867.ref021","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ijsu.2020.05.002","article-title":"Impact of the Coronavirus (COVID-19) pandemic on surgical practice\u2014Part 2 (surgical prioritisation)","volume":"79","author":"A Al-Jabir","year":"2020","journal-title":"Int J Surg"},{"key":"pone.0280867.ref022","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ijsu.2020.07.002","article-title":"Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study","volume":"80","author":"O Cano-Valderrama","year":"2020","journal-title":"Int J Surg"},{"issue":"5","key":"pone.0280867.ref023","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1016\/S2352-4642(20)30108-5","article-title":"Delayed access or provision of care in Italy resulting from fear of COVID-19","volume":"4","author":"M Lazzerini","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"pone.0280867.ref024","first-page":"w20227","article-title":"Recommendations for the admission of patients with COVID-19 to intensive care and intermediate care units (ICUs and IMCUs)","volume":"150","author":"Swiss Society Of Intensive Care M","year":"2020","journal-title":"Swiss Med Wkly"},{"issue":"8","key":"pone.0280867.ref025","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.jacr.2020.06.002","article-title":"Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Changes in Clinical Presentation and CT Findings","volume":"17","author":"J Romero","year":"2020","journal-title":"J Am Coll Radiol"},{"issue":"11","key":"pone.0280867.ref026","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/j.jacr.2021.09.007","article-title":"Erratum","volume":"18","year":"2021","journal-title":"J Am Coll Radiol"},{"issue":"8","key":"pone.0280867.ref027","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1007\/s00268-020-05599-8","article-title":"The Decreasing Incidence of Acute Appendicitis During COVID-19: A Retrospective Multi-centre Study","volume":"44","author":"J Tankel","year":"2020","journal-title":"World J Surg"},{"issue":"4","key":"pone.0280867.ref028","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1177\/0036933020956316","article-title":"Management of appendicitis during COVID-19 pandemic; short-term outcomes","volume":"65","author":"R Ganesh","year":"2020","journal-title":"Scott Med J"},{"key":"pone.0280867.ref029","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.ijsu.2020.05.061","article-title":"International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review","volume":"79","author":"L Moletta","year":"2020","journal-title":"Int J Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0280867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T18:33:17Z","timestamp":1674671597000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0280867"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,1,25]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0280867","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,25]]}}}