Impact of COVID-19 on Abdominal Pain Presentations and Hospital Outcomes in New South Wales: Findings From the ICON Study.

OBJECTIVE

To examine trends in emergency department (ED) presentations, hospital admissions, and patient outcomes for abdominal pain across New South Wales (NSW) before, during, and after the first COVID-19 lockdown.

METHODS

This multi-centre retrospective study analysed de-identified administrative data from NSW public hospitals. ED presentations and hospital admissions for abdominal pain were reviewed across five 31-day periods: pre-pandemic, lockdown, and 3-, 6-, and 12-months post-lockdown.

RESULTS

A total of 35,327 abdominal pain ED presentations were identified. Presentations fell by 31.0%, from 7531 pre-pandemic to 5199 during lockdown, then increased steadily to 7942 (5.5% above baseline) at 12 months. Acuity shifted, with urgent triage cases rising from 57.6% to 61.7%, while semi-urgent cases declined. Ambulance arrivals grew from 23.4% to 28.5% during lockdown, offset by fewer walk-ins. Hospital admissions rose from 2517 at baseline to 2733 at lockdown onset, peaking at 3017 at 3 months later a 19.9% increase (χ2 = 92.28, df = 4, p < 0.0001). Emergency admissions showed a similar pattern (χ2 = 156.81, df = 4, p < 0.0001). Surgical admissions increased from 697 (32.8%) to 840 (38.2%) initially, before declining to 750 (34.2%) at 12 months (p < 0.01). ICU admission rates remained stable, though average ICU hours fluctuated. The mean length of stay for acute overnight admissions shortened from 6.6 days pre-pandemic to 6.0 days during lockdown, returning to 6.5 days by 12 months.

CONCLUSIONS

The COVID-19 pandemic substantially altered patterns of abdominal pain presentations and hospital use, with lasting changes in acuity and admission practices.