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Cohen RB, Severance G, Olafson SN, Ward CL, Parsikia A, Bloom AR, Moran B, Kaplan MJ, Leung P. Laparoscopic Cholecystectomy in the Time of Coronavirus: A Level-1 Trauma Center's Experience. Am Surg 2023; 89:4632-4639. [PMID: 36070958 DOI: 10.1177/00031348221121552] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC), one of the most common surgical procedures performed in the U.S., offers a window into the effects of the COVID-19 pandemic on routine surgical care. The purpose of our study was to analyze the effects of the COVID-19 pandemic at a Level-1 trauma center on the performance rate of non-elective LC over time. METHODS A retrospective chart review from July 2019 to December 2020 identified all non-elective LC cases performed at a level-1 trauma center. Patients were categorized into 4 temporal phases along the course of the pandemic based on statewide incidence data on COVID-19: pre-pandemic, peak 1, recovery, and peak 2. We compared the phases based on demographic information and outcomes. RESULTS In total, 176 patients were reviewed. The performance rate in cases/day varied as follows: pre-pandemic .61, 1st peak .34, recovery .44, and 2nd peak .53. The complication rate was highest in the 2nd peak (16%) (P < .05). Compared to the pre-pandemic period, the intra-pandemic period had a higher incidence of complicated gallbladder disease (P < .05). In the non-elderly subgroup, complicated gallbladder disease was significantly more prevalent in the intra-pandemic period compared to the pre-pandemic period (25% vs 10%, P < .05). CONCLUSIONS Our data suggests a learning curve throughout the course of the pandemic, reflecting a stepwise increase in the performance rate of LC. The higher incidence of complicated gallbladder disease in the intra-pandemic period may imply patient hesitancy to seek routine surgical care, especially among younger patients.
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Affiliation(s)
- Ryan B Cohen
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Severance
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Samantha N Olafson
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Candace L Ward
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Afshin Parsikia
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexi R Bloom
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin Moran
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark J Kaplan
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Pak Leung
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
- Department of Surgery, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
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Cochrun SL, Finnegan T, Kennedy GE, Garland M, Grams JM, Parmar AD. A retrospective single-institution review of the impact of COVID-19 on severity of biliary disease. Am J Surg 2023; 225:352-356. [PMID: 36243562 PMCID: PMC9513400 DOI: 10.1016/j.amjsurg.2022.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic possessed far-reaching health implications beyond the public health impact that have yet to be fully elucidated. We hypothesized that the COVID-19 pandemic led to an increase in biliary disease complexity and incidence of emergency cholecystectomy. METHODS We reviewed our institutional experience with cholecystectomy from February 2019-February 2021, n = 912. Pre COVID-19 pandemic patients were compared to patients after the onset of the pandemic. Baseline characteristics were compared between groups. A Cochran-Armitage test for trend assessed the temporal impact of COVID-19 on emergency presentation and gallbladder disease complexity. RESULTS We identified 442 patients pre-pandemic and 470 patients during the pandemic. No significant differences were noted in demographics. COVID-19 significantly impacted emergency presentation (43.2% vs. 56.8%, p= <0.01), cholecystitis (53.2% vs 61.8%; p=<0.01), and gangrenous cholecystitis (2.8% vs 6.1%; p=<0.01). Both groups had similar clinical outcomes. CONCLUSIONS The COVID-19 pandemic affected an increased incidence of emergency presentation and complexity of gallbladder disease but did not significantly impact clinical outcomes. These findings may have broader implications for other diseases possibly affected by COVID-19.
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Affiliation(s)
- Steven L Cochrun
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Timothy Finnegan
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grace E Kennedy
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mason Garland
- Department of Surgery, Mercer University School of Medicine, Macon, GA, USA
| | - Jayleen M Grams
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abhishek D Parmar
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Demetriou G, Wanigasooriya K, Elmaradny A, Al-Najjar A, Rauf M, Martin-Jones A, Aboul-Enein MS, Robinson S, Perry A, Wadley MS, Mourad M. The impact of the COVID-19 pandemic on elective laparoscopic cholecystectomy: A retrospective Cohort study. Front Surg 2022; 9:990533. [PMID: 36570808 PMCID: PMC9768355 DOI: 10.3389/fsurg.2022.990533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on elective surgery for benign disease. We examined the effects of COVID-19 related delays on the outcomes of patients undergoing elective laparoscopic cholecystectomy (LC) in an upper gastrointestinal surgery unit in the UK. We have analysed data retrospectively of patients undergoing elective LC between 01/03/2019 to 01/05/2019 and 01/04/2021 to 11/06/2021. Demographics, waiting time to surgery, intra-operative details and outcome data were compared between the two cohorts. Indications for surgery were grouped as inflammatory (acute cholecystitis, gallstone pancreatitis, CBD stone with cholangitis) or non-inflammatory (biliary colic, gallbladder polyps, CBD stone without cholangitis). A p value of <0.05 was used for statistical significance. Out of the 159 patients included, 106 were operated pre-pandemic and 53 during the pandemic recovery phase. Both groups had similar age, gender, ASA-grades and BMI. In the pre-pandemic group, 68 (64.2%) were operated for a non-inflammatory pathology compared to 19 (35.8%) from the recovery phase cohort (p < 0.001). The waiting time to surgery was significantly higher amongst patients operated during the recovery phase (p = 0000.1). Less patients had complete cholecystectomy during the pandemic recovery phase (p = 0.04). There were no differences in intraoperative times and patient outcomes. These results demonstrate the impact of COVID-19 related delays to our cohort, however due to the retrospective nature of this study, the current results need to be backed up by higher evidence in order for strong recommendations to be made.
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Affiliation(s)
- George Demetriou
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom,Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom,Correspondence: George Demetriou
| | - Kasun Wanigasooriya
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom,College of Medical and Dental Science, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, United Kingdom
| | - Ahmed Elmaradny
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Ammar Al-Najjar
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Mohammad Rauf
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Alicia Martin-Jones
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Mohamed Saad Aboul-Enein
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom,General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Steven J Robinson
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Anthony Perry
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Martin S Wadley
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
| | - Moustafa Mourad
- Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom
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Rocco M, Oliveira BLDE, Rizzardi DAA, Rodrigues G, Oliveira GDE, Guerreiro MG, Cruz VS, Naufel-Junior CR. Impact of the COVID-19 Pandemic on Elective and Emergency Surgical Procedures in a University Hospital. Rev Col Bras Cir 2022; 49:e20223324. [PMID: 36000684 PMCID: PMC10578855 DOI: 10.1590/0100-6991e-20223324-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/15/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE to assess the impact of the COVID-19 pandemic on abdominal wall hernia repair surgeries and cholecystectomy in a referral center hospital. METHODS a retrospective, observational, cross-sectional study carried out at Hospital Universitário Evangélico Mackenzie (HUEM), in Curitiba, Paraná, Brazil. Data obtained through electronic medical records of patients who underwent cholecystectomy and abdominal wall hernia repair from March to December 2019 and 2020 at HUEM were included. Data were analyzed using Pearsons Chi-Square test and analysis of variance (ANOVA). RESULTS a total of 743 medical records were analyzed, with a 63.16% drop in the total number of surgeries in 2020. There was a 91.67% increase in the number of ICU admissions in 2020, as well as a 70% increase in average length of stay. A greater number of complications was observed (in 2020, 27% had complications, while in 2019 this figure was 18.8%) and an increase in mortality (in 2019, this rate was 1.3% and in 2020, 6.5%). There were 6 cases of COVID-19 in 2020, so that of these, 5 patients died. CONCLUSION during the COVID-19 pandemic, an important reduction in the number of abdominal wall hernia repair surgeries and cholecystectomy was observed. In addition, there was a statistically significant increase in postoperative complications, mortality rate and length of stay in 2020.
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Affiliation(s)
- Mateus Rocco
- - Faculdade Evangélica Mackenzie do Paraná - Curitiba - PR - Brasil
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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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Liapis SC, Stavrou A, Perivoliotis K, Christodoulou P, Kalodimos G, Kitsakis G, Kapatou K, Ziamas D, Lytras D. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac205. [PMID: 35615703 PMCID: PMC9126066 DOI: 10.1093/jscr/rjac205] [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: 03/14/2022] [Revised: 03/21/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stavros Chrysovalantis Liapis
- Correspondence address. Department of Surgery, General Hospital of Volos, Magnesia, Thessaly, Greece, Polymeri 134. Tel:+302421351403; E-mail:
| | - Alexios Stavrou
- Department of Surgery, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
| | | | - Prokopis Christodoulou
- Department of Surgery, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
| | - Georgios Kalodimos
- Department of Histopathology, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
| | - Georgios Kitsakis
- Department of Histopathology, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
| | - Kassiani Kapatou
- Department of Histopathology, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
| | - Dimitrios Ziamas
- Department of Surgery, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
| | - Dimitrios Lytras
- Department of Surgery, General Hospital of Volos Achillopouleio, Volos, Magnesia, Thessaly, Greece
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ROCCO MATEUS, OLIVEIRA BRUNALARISSADE, RIZZARDI DARINAANDRADEADDARIO, RODRIGUES GABRIEL, OLIVEIRA GABRIELYDE, GUERREIRO MILENAGONÇALVES, CRUZ VINÍCIUSSIPPEL, NAUFEL-JUNIOR CARLOSROBERTO. Impacto da Pandemia por COVID-19 nos Procedimentos Cirúrgicos Eletivos e Emergenciais em Hospital Universitário. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: avaliar o impacto da pandemia da COVID-19 em cirurgias de reparo de hérnias de parede abdominal e colecistectomia em hospital centro de referência. Métodos: estudo transversal retrospectivo observacional realizado no Hospital Universitário Evangélico Mackenzie (HUEM), em Curitiba, Paraná, Brasil. Foram incluídos os dados obtidos através de prontuários eletrônicos de pacientes que realizaram colecistectomia e reparo de hérnias de parede abdominal no período de março a dezembro de 2019 e 2020 no HUEM. Os dados foram analisados por meio do teste Qui-Quadrado de Pearson e aplicação da Análise de Variância (ANOVA). Resultados: Foram analisados 743 prontuários ao todo, sendo constatada uma queda de 63,16% no número total de cirurgias no ano de 2020. Verificou-se um aumento de 91,67% no número de internações em UTI em 2020, bem como um aumento de 70% no tempo médio de internação. Foi observado um maior número de complicações (em 2020, 27% apresentaram complicações, enquanto em 2019 este valor foi de 18,8%) e um aumento em relação à mortalidade (em 2019, esta taxa foi de 1,3% e em 2020, 6,5%). Observaram-se 6 casos de COVID-19 em 2020, de modo que destes, 5 pacientes vieram a óbito. Conclusão: durante a pandemia da COVID-19, observou-se uma importante redução na quantidade de cirurgias de reparo de hérnia de parede abdominal e colecistectomia. Além disso, houve aumento estatisticamente relevante quanto às complicações pós-operatórias, taxa de mortalidade e tempo de internamento em 2020.
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Affiliation(s)
- MATEUS ROCCO
- Faculdade Evangélica Mackenzie do Paraná, Brasil
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