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The impact of the COVID-19 pandemic on elective laparoscopic cholecystectomy: A retrospective Cohort study
George Demetriou1,2, Kasun Wanigasooriya1,3, Ahmed Elmaradny1
1Department of Upper Gastrointestinal and Bariatric Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, United Kingdom.
Insights
The COVID-19 pandemic significantly delayed elective laparoscopic cholecystectomy (LC) surgeries. While patient outcomes remained similar, fewer patients received complete cholecystectomies during the pandemic recovery phase.
Area of Science:
- Gastrointestinal Surgery
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic disrupted elective surgical procedures globally.
- Benign gallbladder disease management, including laparoscopic cholecystectomy (LC), was affected by these disruptions.
Purpose of the Study:
- To evaluate the impact of COVID-19 related delays on patient outcomes for elective laparoscopic cholecystectomy (LC).
- To compare surgical indications, waiting times, and outcomes between pre-pandemic and pandemic recovery phases.
Main Methods:
- Retrospective analysis of 159 patients undergoing elective LC between March 2019-May 2019 (pre-pandemic) and April 2021-June 2021 (pandemic recovery).
- Comparison of demographics, waiting times, surgical indications (inflammatory vs. non-inflammatory), intra-operative details, and patient outcomes between the two cohorts.
- Statistical significance determined using a p-value < 0.05.
Main Results:
- The pandemic recovery cohort had significantly longer waiting times for LC (p=0.0001).
- Fewer patients in the recovery cohort underwent complete cholecystectomy (p=0.04).
- No significant differences were observed in intra-operative times or patient outcomes between the groups.
Conclusions:
- COVID-19 related delays impacted the management of elective laparoscopic cholecystectomy patients, altering surgical indications and procedure completion.
- Despite delays, patient outcomes were not significantly different, but further high-evidence studies are needed to confirm these findings and guide recommendations.
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.
