Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study

Abstract

Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015–March 2020, was compared to the period April 2020–March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020–March 2021 in the previous 5 years was 0.960 ( p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 ( p = 0.008), on patients aged 65–80 years was 0.964 ( p = 0.423), on patients aged >80 years was 1.336 ( p = 0.025), on men was 1.001 ( p = 0.841), on women was 0.934 ( p = 0.006), on procedures completed laparoscopically was 0.964 ( p = 0.190), on procedures completed with open approach was 0.659 ( p = 0.044), on acute procedures was 1.218 ( p = 0.016), on planned procedures was 0.791 ( p < 0.001), on procedures performed for biliary colic was 0.808 ( p < 0.001), on procedures performed for acute cholecystitis was 1.274 ( p = 0.012), for biliary pancreatitis was 1.192 ( p = 0.037), and for obstructive jaundice was 1.366 ( p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a continuation of a long-term trend toward more acute surgery remains unanswered. Further studies are needed to assess and evaluate how this has affected public health and health economics.

The Swedish Perioperative Register: Description, validation of data mapping and utility

“…Although there are published articles based on data extracted from the SPOR database, 4 , 10 , 11 , 12 this is the first study systematically examining the validity of at least some of the data collected locally and then automatically mapped and transferred to a national database. Reassuringly, several key variables did reach a high degree of agreement between a local source database and the national database at UCR.…”

Obstructive jaundice treatment during the COVID-19 pandemic: retrospective cohort study at a single tertiary care center in Serbia

“…There was no increase in ERCP cases performed for CBD stones during the pandemic. 3 The present study focused on patients with obstructive jaundice whose total bilirubin levels (mean value 266.1 μmol/L) indicated accelerated treatment. The time-sensitive nature of treating patients with jaundice (via surgery or endoscopic treatment) creates a specific situation that can be considered semi-urgent owing to the multisystem consequences of obstructive jaundice.…”

“…The COVID-19 pandemic has tested the resilience of health care systems worldwide, with elective surgical procedures being limited or suspended during the first waves of the pandemic. [1][2][3] A large body of research has been focused on mortality related to COVID-19, the influence of the pandemic on the surgical treatment of various benign and malignant diseases, [4][5][6][7] as well as the nosocomial spread of COVID-19. 5 Infection with the causative agent of COVID-19, namely, SARS-CoV-2, is considered a significant health risk in the perioperative period, with both short and long-term consequences such as chronic pulmonary dysfunction, myocarditis, renal impairment, thrombotic events, and chronic fatigue.…”

“…12 Obstructive jaundice is a potentially lifethreatening complication of gallstone disease (choledocholithiasis), together with biliary pancreatitis and acute cholangitis. 3 Rates of perioperative morbidity in patients with obstructive jaundice range from 20% to 30%. 12 The aim of the present study was to compare the mortality and complication rate of patients undergoing treatment for obstructive jaundice before and during the COVID-19 pandemic in a tertiary care center in Serbia.…”

“…12 Obstructive jaundice is a potentially life-threatening complication of gallstone disease (choledocholithiasis), together with biliary pancreatitis and acute cholangitis. 3 Rates of perioperative morbidity in patients with obstructive jaundice range from 20% to 30%. 12…”