Impact of the COVID-19 Pandemic on the Management of Gallbladder, Biliary Tract, and Pancreatic Diseases

Introduction Biliary diseases are a major acute general surgical burden. Laparoscopic cholecystectomy is the gold standard surgical procedure, although it was discontinued during an outbreak. Effective management permits decisive therapy, symptom alleviation, and fewer hospitalizations and complications. Throughout the initial COVID-19 situation, surgical procedures for patients were delayed. Invasive services were required to employ conservative or non-operative therapy, which could lead to increased recurring presentations and biliary-pancreatic problems. Aim Examining the impact of COVID-19 on the outcomes and hospitalizations of patients suffering from gallstone, biliary tract, and pancreatic diseases.  Methods The retrospective analysis included patients with the following ICD-10 codes who presented to our unit: cholelithiasis (K80), cholecystitis (K81), and acute pancreatitis (K85). We compared the interval of the first COVID-19 pandemic wave, from March to August 2020, with the period before the pandemic, referred to as Pre-COVID-19. After applying exclusion criteria, a total of 868 patients were enrolled in the trial, having initially recruited around 1,400 individuals using these codes. Patients with inaccurate coding, cancer, or non-stone disease were excluded (e.g., alcoholic pancreatitis). The demographic information, admission details, investigations, surgical therapy, operating specifics, and postoperative complications of the patients were noted. Changes in surgical management, patient representation, and postoperative complications were the key outcomes. Results A statistically significant (p<0.05) rise was seen in repeat presentations in the COVID group, most likely due to the failure of definitive treatment. The other outcome is the distribution of presentations was comparable, patients with acute cholecystitis and gallstone pancreatitis showed statistically significant (p<0.05) lower rates of definitive therapy. Conclusion During the COVID period, all surgeries except those for cancer were halted. Unknown causes led to several consequences related to the gallbladder, biliary tract, and pancreas. Patients with cholecystitis, gallstone pancreatitis, and pancreatic inflammation experienced a lower probability of treatment. The increase in hospitalizations and self-presentations indicated that definitive therapy, designed to restrict COVID-19 exposure, actually increased patient risk. Despite this risk, we had no COVID-19 instances in our cohort. The evaluation of the long-term consequences of the pandemic on acute pancreatitis and its care will require a large-scale, multicenter investigation.

1496 Building Inclusivity and Diversity from our Foundations: A Cross-Sectional Study Identifying Barriers to Theatre Based Training for Foundation Doctors

Aim

Theatre experience is a powerful factor enabling trainees to determine whether they possess the enthusiasm and aptitude to undertake a surgical career. Removing barriers to theatre learning should allow a more meritorious and diverse cohort of surgical trainees.

Method

An 18 -point open and closed question Likert scale survey was distributed to Foundation Doctors in three hospitals within the Northern Deanery. The survey was designed via focus group and literature review, ascertaining perceived levels of preparedness, acceptance, enjoyment, and barriers to theatre access.

Results

The survey dichotomized respondents (n = 54) into those who attended theatre (n = 40) and those who did not (n = 14). Of those attending 38% (n = 15) reported intimidation and 15% (n = 6) cited a cultural barrier to attendance. Of those who did not attend 79% (n = 11) were interested in surgery. These respondents predominantly reported concerns around prohibitive ward workload and unfamiliarity with protocols. Covid restricted surgical rotations for some. There was a statistically significant difference (p fishers exact test = 0.001) between 83% of respondents who felt welcomed by the surgeons compared to just 45% made to feel welcome by the wider theatre team. Only 20% (n = 11) of respondents felt prepared for theatre by medical school. 50% (n = 27) were confident with theatre protocols.

Conclusions

The study raises concerns around apprehension surrounding the theatre environment and ward workload which appear to impede access to theatre. Adequate undergraduate surgical teaching, appropriate induction and allocation of theatre time are crucial to improve safety, diversity of applicants, confidence for trainees and compliance within the team.