Conference 2021 Pre-Recorded Video
Outcomes of gallstone complications during the COVID Pandemic
Authors and Affiliations
Isherwood J1, Karki B1, Chung WY1, AlSaoudi T1, Wolff J1, Malde D1, Bhardwaj N1, Garcea G1, Dennison AR1
1.Department of HPB, University Hospitals of Leicester NHS Trust
As data and metadata from the SARS-CoV-2 pandemic matures the true impact on non-cancer, nonemergency surgical practice is becoming apparent forcing all surgical services to rapidly adopt different working practices. One widely employed practice was the increased utilisation of radiological, percutaneous procedures such as cholecystostomy for complicated gallstone disease. The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate.
This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019.
Patients presenting to the HPB unit with a coded diagnosis of gallstones (ICD 10 codes K80.8, K80.1 and K80.2) were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p=0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). There was also a non-significant increase in patients presenting with gallstone pancreatitis compared with 2019 (74 vs 61). As anticipated, there was a 45% decrease in the number of emergency cholecystectomies performed during the pandemic compared with 2019 (201 vs 365). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al.
In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent National approach is required to mitigate these risks.