Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 — an Analysis of 12,545 Patients from a German-Wide Hospital Network

Abstract

Purpose To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021. Methods Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis. Results We could not demonstrate differences in daily admissions over the course of the pandemic (11.2–12.7 patients vs. 11.9–12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7–17.3% vs. 14.5–18.4%). Cholecystostomy was rare throughout all periods (0–0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4–5.5%). Mortality was generally low (1.5–1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods. Conclusion The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-022-05318-9.

Multidisciplinary management of acute cholecystitis during the COVID-19 pandemic

“…In addition, it should be noted that as regards surgical therapy at our department (either primary or secondary), CR and LSR were similar in both periods and the rate of laparoscopic procedures did not fall during the pandemic despite the fact that we faced more difficult cases. Laparoscopic cholecystectomy was safely used during the pandemic, as also demonstrated in a large number of cohorts 15 .…”

Impact of the COVID‐19 pandemic on outcomes of cholecystectomy for acute cholecystitis: a national cohort study

“…This finding is broadly consistent with other surgical studies conducted overseas. Siegel et al 39 . performed a retrospective analysis of 5604 patients in Germany with acute cholecystitis between pre‐pandemic and pandemic phases and found no significant difference in mortality, length of stay, or postoperative complications across time periods.…”

“…This finding is broadly consistent with other surgical studies conducted overseas. Siegel et al 39 performed a retrospective analysis of 5604 patients in Germany with acute cholecystitis between prepandemic and pandemic phases and found no significant difference in mortality, length of stay, or postoperative complications across time periods. Further, Hillebrandt et al 40 conducted a large cross-sectional study comprising 10 723 German patients undergoing surgery and reported that while the COVID-19 pandemic was associated with a slighter higher rate of mortality and specific postoperative complications, these findings were likely secondary to changes in indication for surgery (i.e., more urgent or major operations being done during the pandemic) rather than poorer quality or accessibility of healthcare.…”

No Causal Association Between Cholelithiasis and COVID-19: A Bidirectional Mendelian Randomization Study

“…Terrifying symptoms and complications occur during and afterwards the infection, such as fatigue, loss of the sense of smell or taste, impaired pulmonary function and neurological diseases [6,7]. Recent literatures have stated novel guideline to cope with cholelithiasis and cholecystitis, especially whether to conduct cholecystectomy is in a dilemma during this pandemic [8][9][10][11]. In addition, forward and reverse causal relationship between gallstone diseases and cholecystectomy and the COVID-19 events have not been comprehensively demonstrated yet.…”