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Alzerwi NAN, Rayzah M, Alnemare AK, Elkhalifa AME. Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies. Healthcare (Basel) 2023; 12:96. [PMID: 38201002 PMCID: PMC10779415 DOI: 10.3390/healthcare12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic significantly disrupted surgical care worldwide, affecting different specialties in various ways. Lockdowns, surges in COVID-19 cases, and changes in hospital policies notably impacted patient attendance, management practices, and access to surgical services. This scoping review examines the adverse impacts of the COVID-19 pandemic on surgical services and the policies adopted to address these care barriers. METHODS We conducted a comprehensive literature review using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Our search, spanning 31 December 2019, to 29 January 2023, focused on understanding the multifaceted impacts of COVID-19 on surgical services, particularly across different specialties. RESULTS An analysis of 75 articles indicated that the pandemic challenged surgeons worldwide to maintain a balance between delivering emergency and elective surgical care, and implementing safety measures against viral transmission. There was a marked decline in the surgical volume, leading to extended waitlists and decreased operating theater usage. Strategies such as prioritizing medically necessary and time-sensitive surgeries and integrating telemedicine have emerged as pivotal for ensuring the continuity of urgent care. Despite the reduced rates, essential surgeries such as appendectomies and cancer-related operations continued, yet faced hurdles, including reduced staffing, limited operating theater capacity, and complications in patient transfers. CONCLUSIONS This review emphasizes the steep reduction in surgical service utilization at the beginning of the pandemic and emergence of new compounded barriers. Policies that designated surgeries as essential, and focused on equitable and timely access, were effective. Incorporating these findings into post-pandemic assessments and future planning is crucial to sustain adequate surgical care during similar health emergencies.
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Affiliation(s)
- Nasser A. N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia
| | - Musaed Rayzah
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia
| | - Ahmad K. Alnemare
- Otolaryngology Department, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia;
| | - Ahmed M. E. Elkhalifa
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 11673, Saudi Arabia;
- Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti 1158, Sudan
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Heinz J, Walshaw J, Kwan JY, Long J, Carradice D, Totty J, Kontouli KM, Lainas P, Hitchman L, Smith G, Huo B, Guadalajara H, Garcia-Olmo D, Sharma D, Biyani CS, Tomlinson J, Loubani M, Galli R, Lathan R, Chetter I, Yiasemidou M. PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol. Front Surg 2023; 10:1251444. [PMID: 37818209 PMCID: PMC10560728 DOI: 10.3389/fsurg.2023.1251444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
Background Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. Methods This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using QualtricsXM Platform™ through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses. Discussion Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.
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Affiliation(s)
- J Heinz
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Walshaw
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - J Y Kwan
- Leeds Vascular Institute, Leeds Teachings Hospitals NHS Trust, Leeds, United Kingdom
| | - J Long
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - D Carradice
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Totty
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - K M Kontouli
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - P Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Partis-Saclay University, Clamart, France
| | - L Hitchman
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - G Smith
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - B Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - H Guadalajara
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - D Garcia-Olmo
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - D Sharma
- Department of Surgery, Government NSCB Medical College, Jabalpur, India
| | - C S Biyani
- Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Tomlinson
- Trauma and Orthopedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - M Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - R Galli
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - R Lathan
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - I Chetter
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - M Yiasemidou
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
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Lima MIDE, Fonseca Neto OCLDA. Acute abdomen in patients with covid-19: an integrative review. Rev Col Bras Cir 2023; 50:e20233576. [PMID: 37646728 PMCID: PMC10508665 DOI: 10.1590/0100-6991e-20233576-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients. METHODOLOGY this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective. RESULTS the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions. CONCLUSION the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.
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Affiliation(s)
| | - Olival Cirilo Lucena DA Fonseca Neto
- - Universidade de Pernambuco, Faculdade de Ciências Médicas - Recife - PE - Brasil
- - Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz (HUOC) - Recife - PE - Brasil
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Andersson RE, Agiorgiti M, Bendtsen M. Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: a Systematic Review and Meta-analysis. World J Surg 2023; 47:1901-1916. [PMID: 37140609 PMCID: PMC10158710 DOI: 10.1007/s00268-023-07027-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. METHOD We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND ("COVID" OR SARS-Cov2 OR "coronavirus"). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. RESULTS The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). CONCLUSION The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.
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Affiliation(s)
- Roland E Andersson
- Department of Surgery, County Hospital Ryhov, Box 1024, SE 551 11, Jönköping, Region Jönköpings Län, Sweden.
- Futurum, Academy for Health and Care, Jönköping, Region Jönköpings Län, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Maria Agiorgiti
- Bra Liv Eksjö Primary Care Centre, Eksjö, Region Jönköping County, Sweden
- Department of Experimental Physiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Guadalajara H, Yiasemidou M, Muñoz de Nova JL, Sedman P, Fernandez Gonzalez S, Maslekar S, Recarte Rico M, Egan R, Juez LD, Riyad K, García Septiem J, Lockwood S, Galindo Jara P, Giorga A, García Virosta M, Hance J, Lobo Martínez E, Martín-Pérez E, Howitt A, Jayne D, Chetter I, García-Olmo D, Fernández-Cebrián JM, Jover JM, Acín-Gándara D, Perea-del-Pozo E, Dios-Barbeito S, Aparicio-Sánchez D, Durán-Muñoz-Cruzado VM, Pareja-Ciuró F, Martin-Antona E, Cano-Valderrama O, Torres-Garcia AJ, Zarain-Obrador L, Durán-Poveda M, Peinado-Iribar B, Fernandez-Luengas D, Pascual-Migueláñez I, Garcia-Chiloeches A, Puerta A, Martín-Pérez E, García-del-Álamo-Hernández Y, Maqueda-González R, Gutiérrez-Samaniego M, Colao-García L, Núñez-O’Sullivan S, Vaquero MA, Picardo-Nieto A, Blazquez-Martin A, Vera-Mansilla C, Soto-Schüte S, Gutiérrez-Calvo A, Mínguez-García J, Sanchez-Argüeso A, Hernández-Villafranca S, Qian-Zhang S, Gortazar-de-las-Casas S, Dominguez-Prieto V, Lopez-Fernandez O, Casalduero-García L, Iparraguirre MÁ, Florez-Gamarra M, Argüello-de-Andrés JM, Tallón-Iglesias B, Pereira-Perez F, García-Ureña MÁ, Paeriro G, Fuenmayor-Valera ML, Pardo R, Pellen M, Basheer M, Harries R, Parkins K, Spencer N, Li Z, Burridge J, Wynn H, Mesri M. The international PIACO study: pattern of surgical approaches for acute surgical pathologies in Spain versus UK. Was conservative treatment and open surgery during COVID-19 the way to go? BJS Open 2022; 6:6658292. [PMID: 35939374 PMCID: PMC9359448 DOI: 10.1093/bjsopen/zrac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hector Guadalajara
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
| | | | - José Luis Muñoz de Nova
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Peter Sedman
- Upper Gi Surgery, Hull University Teaching Hospitals , Hull , UK
| | - Saul Fernandez Gonzalez
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
| | | | - María Recarte Rico
- Department of General and Digestive Surgery, Tajo University Hospital , Madrid , Spain
| | - Richard Egan
- Department of General Surgery, Swansea Bay UHB, Swansea University , Swansea, Wales , UK
| | - Luz Divina Juez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital , Madrid , Spain
| | | | - Javier García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Sonia Lockwood
- Colorectal Surgery, Bradford Teaching Hospitals , Bradford , UK
| | - Pablo Galindo Jara
- Department of General and Digestive Surgery, Torrejon University Hospital , Madrid , Spain
| | - Andrea Giorga
- Colorectal Surgery, Leeds Teaching Hospitals , Leeds , UK
| | - Mariana García Virosta
- Department of General and Digestive Surgery, Infanta Sofia University Hospital , Madrid , Spain
| | - Julian Hance
- Colorectal Surgery, Leeds Teaching Hospitals , Leeds , UK
| | - Eduardo Lobo Martínez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital , Madrid , Spain
| | - Elena Martín-Pérez
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Annabel Howitt
- Department of Colorectal Surgery, Bradford Teaching Hospitals , Bradford , UK
| | - David Jayne
- Leeds Institute of Biomedical Sciences, University of Leeds , Leeds , UK
| | - Ian Chetter
- Academic Vascular Surgery, University of Hull , Hull , UK
| | - Damian García-Olmo
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
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Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study. Ann Med Surg (Lond) 2022; 77:103721. [PMID: 35531430 PMCID: PMC9065655 DOI: 10.1016/j.amsu.2022.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation. Materials and method All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents’ health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered. Results A total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: −21.9% [−22.5;−21.4]; hip arthroplasty: −13.4% [−14.8;−12.0]; knee arthroplasty: −24.6% [−26.1;−23.0]; coronary angioplasty: −11.2% [−12.7;−9.7]) without any catch–up in the first half of 2021 (cataract surgery: −5.0% [−5.8;−4.3]; hip arthroplasty: −9.9% [−11.6;−8.2]; knee arthroplasty: −22.0% [−24.0;−20.1]; coronary angioplasty: −12,1% [−13.9;−10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (−2.6% [−4.9; −0.3]/+0.6 [−2.2; +3.4]). Conclusion This study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine. Hospitalizations for cataract surgery, coronary angioplasty, hip and knee arthroplasties were strongly impacted by the pandemic from 2020 until the first half of 2021, without any catch-up outside the lockdown periods and despite the gradual rollout of the national COVID-19 vaccine campaign in 2021. Definitive cardiac stimulation was the only surgery not really impacted. Optimize surgical patient care in a pandemic setting and identify ways to improve the available capacity of surgical activity.
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Stavridis K, Liosis I, Konstantinidis MK, Kondylis G, Ioannidis A. COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature. Front Surg 2022; 9:871685. [PMID: 35495756 PMCID: PMC9039201 DOI: 10.3389/fsurg.2022.871685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Since the beginning of the COVID-19 pandemic, many patients with clinically acute presentations have been approached differently. The fear of viral transmission along with the short period of study made patients delay their hospital visits and doctors reassess the approach of certain acute situations. This study aimed to assess the changes in the management of patients with acute cholecystitis before and during COVID-19. Methods A systematic review of the literature using PubMed (MEDLINE), Scopus, and ScienceDirect databases was performed until 01 September 2021. Totally, two kinds of studies were included, those assessing the management of acute cholecystitis during COVID-19 and those comparing the periods before and during the pandemic. The outcomes recorded include management approaches, complications, and mean length of stay. Results A number of 15 eligible articles were included in the study. During the pandemic, six studies revealed a shift toward conservative management of acute cholecystitis and five of them reported that conservative management was opted in 73% of the patients. On the contrary, data from all studies revealed that the surgical approach was preferred in only 29.2% of patients. Furthermore, when comparing the periods before vs. during COVID-19, the conservative approach was reported in 36.3 and 43.2% before vs. during COVID-19, respectively, whereas surgical intervention was performed in 62.5% of patients before COVID-19 and 55.3% during the pandemic. The length of stay was delayed when a non-surgical approach was selected in most studies. Complications, mainly classified by the Clavien-Dindo scale, were higher in the pandemic period. Conclusion A tendency toward more conservative approaches was observed in most studies, reversing the previously used surgical approach in most cases of acute cholecystitis. In most of the examined cases during the COVID-19 pandemic, antibiotic treatment and percutaneous cholecystostomy were much more considered and even preferred.
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Affiliation(s)
| | - Ioannis Liosis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael K. Konstantinidis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, Athens, Greece
- *Correspondence: Michael K. Konstantinidis
| | - Georgios Kondylis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Ioannidis
- Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, Athens, Greece
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