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COVID-19 and Liver Surgery: How the Pandemic Affected an Italian Medium-Volume HBP Center
Francesca Carissimi1,2, Mauro Alessandro Scotti1, Cristina Ciulli1,2
1Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy.
Insights
The COVID-19 pandemic did not significantly impact hepatobiliary surgery outcomes, including length of stay, morbidity, or mortality. Despite increased tumor burden during the pandemic, surgical care volume was maintained.
Area of Science:
- Hepatobiliary Surgery
- Oncology
- Infectious Diseases
Background:
- The COVID-19 pandemic caused significant disruptions to healthcare, including the postponement of elective surgeries.
- Hospitals implemented strategies like COVID-free wards to resume essential surgical procedures.
- The impact on specialized units like hepatobiliary surgery required careful evaluation.
Purpose of the Study:
- To assess the impact of the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) pandemic on a hepatobiliary surgery unit.
- To determine if surgical outcomes were affected by pandemic-related changes.
- To evaluate the effectiveness of COVID-free protocols in maintaining surgical services.
Main Methods:
- Retrospective analysis of a prospective database of liver surgery patients.
- Comparison of data from the pre-COVID period (2018-2019) and the COVID period (2020-2021).
- Inclusion criteria required negative COVID-19 swabs for patients admitted to COVID-free wards.
Main Results:
- 101 patients were treated pre-COVID (Group 1) and 126 during the COVID period (Group 2).
- No significant differences were observed in postoperative hospital stay, major complications, or mortality between the groups.
- A significantly greater tumor burden was noted in Group 2, with larger nodule size, increased lymphadenectomy, and more extrahepatic disease.
Conclusions:
- The hepatobiliary surgery unit successfully maintained surgical volume during the COVID pandemic.
- Pandemic-related protocols allowed for the continuation of tertiary-center care without compromising patient outcomes.
- Despite challenges, including increased tumor burden, the unit demonstrated resilience in providing essential hepatobiliary surgery services.
Introduction:
While the COVID-19 pandemic is still ongoing, it is even more evident that victims of the pandemic are not only those who contract the virus, but also the countless patients suffering from other serious diseases (i.e., tumor) who have undergone delayed potentially life-saving surgery due to a lack of beds. Like many hospitals, ours also initially blocked all elective oncologic surgery, but these operations were "recovered" and reintegrated in a relatively short time, thanks to the establishment of COVID-free wards and operating rooms with staff dedicated to oncological surgery. In tis context, our aim is to assess whether and how the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) pandemic has impacted our hepatobiliary surgery unit.
Methods:
From our prospective database, we retrospectively took data from patients undergoing liver surgery in 2018-2019 (pre-COVID) and 2020-2021 (COVID period). Patients admitted to COVID-free wards must necessarily have a negative nasal swab from the previous 24 h.
Results:
Between January 1, 2018, and December 31, 2019 (Group 1), 101 patients were treated; during the pandemic [January 1, 2020, and December 31, 2021 (Group 2)], 126 patients were treated. There was no statistical difference between the groups. The median postoperative hospital stay was 7 days for both groups; 7 patients had major complications (Clavien-Dindo > 3) in Group 1 and 11 in Group 2 (p = 0.795). A total of 4 patients died in Group 1 and 6 during the pandemic (p = 0.754). Tumor burden was significantly greater in Group 2 where nodule size, lymphadenectomy, and extrahepatic disease were significantly greater (p = 0.011, p = 0.004, and p = 0.026, respectively).
Conclusion:
During the COVID pandemic, our HPB unit managed to offer a volume of tertiary-center hepatobiliary surgery without a significant impact in terms of length of stay, morbidity, or mortality despite the increase in tumor burden during the pandemic years.
