The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States

Abstract

Background In March 2020, the Surgeon General recommended limiting elective procedures to prepare for the COVID-19 surge. We hypothesize a consequence of COVID-19 is reduced operative volume across the country. We aim to examine changes in volume of common gastrointestinal operations during COVID-19, including elective, urgent/emergent, and cancer operations. We also evaluate if hospitals with more COVID-19 admissions were most impacted. Methods The Vizient database was used to determine monthly operative volume from November 2019 to June 2020 for elective operations (hiatal hernia repairs, bariatric surgery), urgent operations (cholecystectomies, appendectomies, inguinal hernia repairs), and cancer operations (colectomies, gastrectomies, esophagectomies). COVID-19 admissions per hospital were also determined. November 2019-January 2020 was defined as "pre-COVID." The monthly reduction in volume from pre-COVID was calculated for each operation. The top quartile (25%) of hospitals with the most COVID admissions were also evaluated separately from hospitals with fewer COVID cases. Data were analyzed using analysis of variance. Results Data from 559 hospitals were analyzed. The volumes of all operations evaluated were significantly reduced during the pandemic except gastrectomies and esophagectomies for cancer. The greatest reduction in all operations was in April. In April, the volume of bariatric surgery reduced by 98% (P < 0.001), hiatal hernia repairs by 96% (P < 0.001), urgent cholecystectomies by 42% (P < 0.001), urgent inguinal hernia repairs by 40% (P < 0.001), urgent appendectomies by 24% (P < 0.001), and colectomies for cancer by 39% (P < 0.001). Hospitals with the most COVID-19 admissions had greater reductions in all operations than hospitals with fewer COVID cases. Conclusions The coronavirus pandemic led to a significant reduction in volume of all gastrointestinal operations evaluated except gastrectomies and esophagectomies. While elective, non-cancer operations were most affected, urgent and some cancer operations also declined significantly. As COVID-19 continues to surge, Americans may suffer continued limited access to surgical care and a significant operative backlog may be forthcoming.

One‐year COVID‐19 outcomes on the oncology care patient pathway: Results of a French descriptive, cross‐sectional comprehensive study (ONCOCARE‐COV)

“…37 A drastic shift (April, −29.1% and May, −20.6%) in the number of oncological surgeries performed, interventional radiology (March, −50%; April −44.4%), and cytoreductive surgery with HIPEC (−100%) was observed. These results are consistent with the conclusions from several studies done throughout the world, 38,39 and may worsen the prognosis. 26 Studies designed in Italy and the UK during the first wave found a respective 20% and 31% decrease in interventional radiology activity which was consistent with our findings.…”

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

“…The significant reduction in cholecystectomies observed during the pandemic has been explained by canceled or postponed non-urgent operations. 17 , 18 This is supported by our data, which demonstrate no significant change of admissions nor surgery for AC. Although some surgeons anecdotally reported a subjective increase of more severe cases of acute cholecystitis with difficult intraoperative presentations, no data has been published so far to support these findings.…”

“… 13 – 16 Data on AC is scarce, because studies analyzed predominantly volume of cholecystectomies, independent of diagnosis or urgency. 17 , 18 In additions, these reports mostly focused on number of admissions or procedures performed, but less on patients’ outcomes or adherence to standard of care. The aim of this study was to assess the incidence and severity of AC as well as quality of surgical treatment throughout different phases of the COVID-19 pandemic.…”

The overall impact of COVID‐19 on healthcare during the pandemic: A multidisciplinary point of view

“…86 Acute appendicitis and cholecystectomy decreased by 32% and 30%, 87 while bariatric surgeries and hiatal hernia repairs dropped by 98% and 96%, respectively. 88 In another survey among breast cancer patients awaiting surgery, more than half of them claimed that COVID-19 pandemics increased their existing oncologic fears. 89 According to a study in the UK, 3 to 6 months delay in cancer surgeries could have terrible effects on life-years gained (LYG's) from cancer surgery which would cause the attributable death of 4755 out of 10 760 cases.…”