Ongoing Impact of COVID in Gall Stone Disease on Patients and Surgeons. Is This Just The Tip of The Iceberg? A Snapshot From An Upper GI Unit

Abstract

Introduction: Covid-19 resulted in a delay to provide cholecystectomy services. We looked at the
effects of the delay on patient morbidity, operative difficulty, and training at our upper GI unit.
Materials And Methods: Data were collected from patients who had cholecystectomy at the
resumption of elective operating services at our DGH. We used Medisec, ICE, and Blue Spire
software to collect data regarding previous admissions, investigations, and operative details. A
proforma was completed after every operation to record the operative findings and difficulty as per
Nassar grades. 101 patients who had cholecystectomy when services resumed from September
2020 after a 5-month pause were included in the study. We looked at the initial presentation,
number of hospital visits, inpatient admissions, diagnoses, operative difficulty, post-operative
complications, hospital stay, 30-day readmissions, and mortality. Results were compared with
Chole S study.
Results: We found a 50% rise in acute cholecystitis, nearly double the number of pancreatitis and
an almost 3 times rise in complications due to choledocholithiasis. Readmissions whilst waiting had
increased by nearly 50%. Nassar grade 4 operations were 50% more, with a significant increase
(p<0.0001, 95% CI) in the operating time. Complications including bile leak were significantly
higher, (p<0.0001, 95% CI). Two-thirds of the operations were done by consultants.
Conclusion: This study from an upper GI unit is a testimony to the adverse effects of delay caused
by covid in terms of morbidity, hospital resources, and training.