Correspondence The Editors welcome topical correspondence pandemic period there was a decrease surgical revision because of surgical from readers relating to articles published in patients undergoing surgery for acute complications. in the Journal. Letters should be submitted cholecystitis (15⋅8 versus 5⋅0 per cent) In summary, during the COVID-19 electronically via the BJS submission site and acute appendicitis (32⋅3 versus 25⋅0 pandemic, surgical activity was reduced (mc.manuscriptcentral.com/bjs). All corres- per cent), and an increase in patients to one-third of the expected level. Coun- pondence will be reviewed and, if approved, who underwent surgery for bowel tries facing this pandemic should con- appear in the Journal. Correspondence must obstruction (8⋅7 versus 14⋅0 per cent) sider this information and adjust their be no more than 300 words in length. and incarcerated hernia (5⋅5 versus 14⋅0 resources to the new situation. A delay per cent) (P = 0⋅179). in patients presenting to the Emergency Considering these results, those Department could be an important fac- Reduction in emergency surgery regions where the COVID-19 pan- tor in this decrease. activity during COVID-19 pandemic demic is now developing should assume in three Spanish hospitals O. Cano-Valderrama1,2,3 , that emergency surgery activity will X. Morales6 , C. J. Ferrigni4 , Editor decrease to one-third of normal. There- E. Martín-Antona1,2,3 , V. Turrado6 , In their recent paper, Spinelli and fore, some of the resources usually A. García4 , Y. Cuñarro-López5 , Pellino talked about emergency surgery assigned to emergency surgery could be L. Zarain-Obrador4 , during the COVID-19 pandemic1 . released and used to attend patients with M. Duran-Poveda4 , J. M. Balibrea6,7 However, they did not mention the COVID-19. and A. J. Torres1,2,3 decrease in emergency surgery that we Several factors could explain this 1 Department of Surgery, Hospital Clínico have observed. Therefore, we com- situation. First, patients delaying vis- San Carlos, 2 Department of Surgery, pared emergency surgery activity in its to the Emergency Department Universidad Complutense, 3 Instituto de three Spanish hospitals during a control to avoid being infected. This could Investigación Sanitaria San Carlos, period (11–26 March 2019) and during result in more advanced disorders, such 4 Department of Surgery, Hospital Rey the pandemic (16–31 March 2020). as complicated appendicitis. Second, Juan Carlos and 5 Department of The study included 127 patients dur- changes in lifestyle during confine- Gynaecology and Obstetrics, Hospital ing the control period and 44 during ment (a low-fat diet, for example) could Gregorio Marañón, Madrid, the pandemic period. A 65⋅4 per cent explain the lower incidence of some and 6 Department of Gastrointestinal decrease in emergency surgery activity diseases (acute cholecystitis). Also, Surgery, Hospital Clínic and 7 Department was observed; the mean number of more patients could be being treated of Surgery, Universidad Autónoma, patients who underwent emergency without surgery (for example, patients Barcelona, Spain surgery daily in each hospital decreased with acute appendicitis treated with from 2⋅6 during the control period to antibiotics). This might explain why dis- DOI: 10.1002/bjs.11667 0⋅9 during pandemic period (P < 0⋅001). orders without alternative treatments, The delay in patients presenting in such as incarcerated hernia or bowel 1 Spinelli A, Pellino G. COVID-19 the Emergency Department (time obstruction, were more frequent during pandemic: perspectives on an unfolding from onset of symptoms to arrival in the the pandemic period. Finally, elec- crisis. Br J Surg. 2020; https://doi.org/ Emergency Department) increased from tive procedures are being postponed, 10.1002/bjs.11627 [Epub ahead of 42⋅1 to 70⋅8 h (P = 0⋅051). During the resulting in fewer patients requiring print]. © 2020 BJS Society Ltd BJS Published by John Wiley & Sons Ltd