International Hepato-Pancreato-Billiary Association (IHPBA) registry study on COVID-19 infections in HPB surgery
David Badrudin1, Mickaël Lesurtel2, Shailesh Shrikhande3
1HPB & Transplant Surgery, Assistant Professor of Surgery, Department of Surgery, Université de Montréal, Montreal, Canada.
Insights
COVID-19 significantly increases mortality and complication risks for hepato-pancreato-biliary (HPB) surgery patients. Elective HPB procedures should be postponed in COVID-19 positive individuals to mitigate these risks.
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Oncology
Background:
- The International Hepato-Pancreato-Biliary Association (IHPBA) established the IHPBA-COVID Registry to collect data on hepato-pancreato-biliary (HPB) surgery outcomes in COVID-19 positive patients before widespread vaccination.
- The registry aimed to inform members about the impact of COVID-19 on HPB surgery outcomes globally.
Purpose of the Study:
- To assess the effects of the COVID-19 pandemic on outcomes of HPB procedures.
- To evaluate perioperative COVID-19 management and surgical care aspects.
- To understand the risks associated with HPB surgery in COVID-19 positive patients.
Main Methods:
- An online, real-time registry was distributed to members of IHPBA and its regional associations (E-AHPBA, A-HPBA, A-PHPBA).
- Data collected included patient outcomes, perioperative management, and surgical care details for HPB procedures in COVID-19 positive patients.
Main Results:
- 125 patients from 35 centers in 18 countries were included; 58% had preoperative COVID-19 diagnosis.
- Operative mortality rates were 28% for pancreaticoduodenectomy, 15% for major hepatectomy, and 2.5% for cholecystectomy.
- Postoperative complication rates were high: 80% for pancreatic, 50% for hepatic, and 37% for biliary interventions, with significant respiratory complications across procedures.
Conclusions:
- HPB surgery in COVID-19 positive patients carries a high risk of mortality and complications, escalating with procedure complexity.
- All HPB interventions showed increased risk, indicating that elective HPB surgery should be deferred in COVID-19 positive patients until after recovery from infection.
Background:
In response to the pandemic, the International Hepato-Pancreato-Biliary Association (IHPBA) developed the IHPBA-COVID Registry to capture data on HPB surgery outcomes in COVID-positive patients prior to mass vaccination programs. The aim was to provide a tool to help members gain a better understanding of the impact of COVID-19 on patient outcomes following HPB surgery worldwide.
Methods:
An online registry updated in real time was disseminated to all IHPBA, E-AHPBA, A-HPBA and A-PHPBA members to assess the effects of the pandemic on the outcomes of HPB procedures, perioperative COVID-19 management and other aspects of surgical care.
Results:
One hundred twenty-five patients from 35 centres in 18 countries were included. Seventy-three (58%) patients were diagnosed with COVID-19 preoperatively. Operative mortality after pancreaticoduodenectomy and major hepatectomy was 28% and 15%, respectively, and 2.5% after cholecystectomy. Postoperative complication rates of pancreatic procedures, hepatic interventions and biliary interventions were respectively 80%, 50% and 37%. Respiratory complication rates were 37%, 31% and 10%, respectively.
Conclusion:
This study reveals a high risk of mortality and complication after HPB surgeries in patient infected with COVID-19. The more extensive the procedure, the higher the risk. Nonetheless, an increased risk was observed across all types of interventions, suggesting that elective HPB surgery should be avoided in COVID positive patients, delaying it at distance from the viral infection.
