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Is it Safe to Perform Elective Colorectal Surgical Procedures during the COVID-19 Pandemic? A Single Institution
Lucas Faraco Sobrado1, Caio Sergio Rizkallah Nahas1, Carlos Frederico Sparapan Marques1
1Divisao de Cirurgia Gastrointestinal e Colorretal, Departamento de Gastroenterologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Insights
Elective colorectal surgery can be safely performed during the COVID-19 pandemic. Preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial to reduce high in-hospital infection mortality rates.
Area of Science:
- Colorectal Surgery
- Infectious Disease Epidemiology
- Public Health
Background:
- The COVID-19 pandemic significantly disrupted healthcare services, including elective surgeries.
- Assessing the safety of non-urgent procedures during this period is critical for patient management.
Purpose of the Study:
- To evaluate the safety and outcomes of elective colorectal surgery performed during the COVID-19 pandemic.
- To determine the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on surgical outcomes.
Main Methods:
- Retrospective, cross-sectional, single-center study.
- Inclusion of patients undergoing elective colorectal surgery between March and September 2020.
- Data collection on patient demographics, surgical procedures, hospital stay, mortality, and SARS-CoV-2 screening.
Main Results:
- 99 elective colorectal surgeries were performed; 4 were postponed due to positive SARS-CoV-2 screening.
- Postoperative COVID-19 infection occurred in 5 patients, with a 60% mortality rate (3/5).
- Overall, 95% of patients (94/99) were safely discharged, with 2.1% mortality from surgical complications unrelated to COVID-19.
Conclusions:
- Elective colorectal surgery can be safely conducted during the pandemic.
- Preoperative SARS-CoV-2 screening is essential to mitigate risks associated with in-hospital transmission.
- High mortality observed in COVID-19 positive surgical patients underscores the importance of stringent preventive measures.
Objectives:
Since the outbreak of the novel coronavirus disease 2019 (COVID-19), all health services worldwide underwent profound changes, leading to the suspension of many elective surgeries. This study aimed to evaluate the safety of elective colorectal surgery during the pandemic.
Methods:
This was a retrospective, cross-sectional, single-center study. Patients who underwent elective colorectal surgery during the COVID-19 pandemic between March 10 and September 9, 2020, were included. Patient data on sex, age, diagnosis, types of procedures, hospital stay, mortality, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperative screening tests were recorded.
Results:
A total of 103 colorectal surgical procedures were planned, and 99 were performed. Four surgeries were postponed due to positive preoperative screening for SARS-CoV-2. Surgical procedures were performed for colorectal cancer (n=90) and inflammatory bowel disease (n=9). Laparoscopy was the approach of choice for 43 patients (43.4%), 53 (53.5%) procedures were open, and 3 (3%) procedures were robotic. Five patients developed COVID-19 in the postoperative period, and three of them died in the intensive care unit (n=3/5, 60% mortality). Two other patients died due to surgical complications unrelated to COVID-19 (n=2/94, 2.1% mortality) (p<0.01). Hospital stay was longer in patients with SARS-CoV-2 infection than in those without (38.4 versushttps://doi.org/10.3 days, respectively, p<0.01). Of the 99 patients who received surgical care during the pandemic, 94 were safely discharged (95%).
Conclusion:
Our study demonstrated that elective colorectal surgical procedures may be safely performed during the pandemic; however, preoperative testing should be performed to reduce in-hospital infection rates, since the mortality rate due to SARS-CoV-2 in this setting is particularly high.
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