Comparative analysis of management of acute cholecystitis during the SARS-CoV-2 coronavirus pandemic

Abstract

Introduction: COVID-19 infection has spread throughout the world and is considered a pandemic. Since its appearance, the number of non-COVID-19 patients admitted to hospitals has decreased and patients differ care for emergency diseases. We analyze the impact of the SARS-CoV-2 coronavirus pandemic on the management of acute cholecystitis. Material and methods: Retrospective observational study that includes all patients diagnosed with acute cholecystitis during the SARS-CoV-2 coronavirus pandemic (period between March 11th and June 21st, 2020) and patients diagnosed with acute cholecystitis in the same period, the previous year in our center. Patient’s features, management, postoperative complications and mean hospital stay were compared. Results: In 2020, 19 patients with acute cholecystitis were diagnosed compared to 21 who were registered in the same period in 2019. The mean number of days from symptoms onset in 2020 was 2.42±1.8 days, while in 2019 it was 3.5±3.1 days (p=0.32). The percentage of cholecystectomies, percutaneous cholecystostomies and conservative management was similar in both periods. Among patients who underwent cholecystectomy in 2020, 37.5% had no complications, 62.5% had accidental opening of the gallbladder, and none had bleeding. Among patients who underwent cholecystectomy in 2019, 81.8% had no complications, 9.09% had accidental opening of the gallbladder, and 9.09% presented bleeding. The mean stay in 2020 was 4.21±3.2 days, compared to 8.57±7.4 days in 2019 (p=0.005). Two patients of 19 diagnosed with acute cholecystitis in 2020 had COVID-19 disease. Conclusion: The mean stay of the patients was shorter in 2020 period. These results can be explained by an early surgical management. So, early laparoscopic cholecystectomy should be considered as a treatment for acute cholecystitis in COVID-19 times if the clinical and hospital situation allows it. We found no differences in the number of patients diagnosed with acute cholecystitis between the two periods, nor in the mean number of days from the onset of symptoms.

COVID-19 with Acute Cholecystitis: A Case Report

“…After the result was shown to be negative, Multidisciplinary team decided to perform an early laparoscopic cholecystectomy as the gold standard for the treatment of most gallbladder disease and for a shorter hospital stay to reduce the risk of nosocomial infection. 16 Laparoscopic cholecystectomy was also preferred than open cholecystectomy because of the lack of evidence about an increased risk of SARS-CoV-2 infection during laparoscopy. 17 The precise mechanism of acute cholecystitis in COVID-19 patients was still unclear.…”

Laparoscopic cholecystectomy during COVID-19 pandemic- Retrospective analysis of tertiary care centre

“…These strategies can reduce the LOS, cost of treatment and reduce the burden of disease and long waiting lists in public hospitals in LMIC. (10)…”

Severidad de la colecistitis aguda en tiempos de COVID-19: ¿mito o realidad?

“…Posterior al inicio de la pandemia por COVID-19 y el manejo social de la cuarentena en nuestro país, subjetivamente se ha considerado una presentación clínica de la patología biliar aguda con mayor grado de severidad según las escalas mencionadas. En la literatura existen algunos estudios que analizan el impacto de la pandemia en el número de pacientes con emergencias quirúrgicas que consultan a los servicios de urgencias 17 , así como los resultados del tratamiento de patologías quirúrgicas de urgencia como la apendicitis aguda y la colecistitis aguda 18,19 . Sin embargo, en nuestro medio no se conoce el comportamiento de la colecistitis aguda en época de pandemia por COVID-19, por tanto, este trabajo tuvo como objetivo comparar la presentación clínico-quirúrgica, basados en las diferentes escalas de severidad de la colecistitis aguda, antes y durante la pandemia por COVID-19.…”

“…Se esperaba que estos primeros datos podrían reflejarse en un aumento de la severidad de presentación clínica y quirúrgica de los pacientes con colecistitis aguda durante la pandemia, sin embargo, al analizar el tiempo entre el ingreso al hospital y el procedimiento quirúrgico, este fue mucho menor en el período actual de pandemia, con una diferencia estadisticamente significativa (70,93 vs. 42,29) (p<0,001). Así mismo al realizar un análisis entre el tiempo transcurrido entre el inicio de los síntomas y la entrada al quirófano, la demora en consulta en la epoca de pandemia se equilibra con el menor tiempo de entrada al quirófano, sin diferencias estadísticamente significativas entre los dos periodos, resultados comparables con estudios similares en la literatura, en donde se logró identificar una disminución de la estancia hospitalaria debido al manejo quirúrgico temprano, con medias de 4,21 ± 3,2 días en el 2020 comparado con 8,57 ± 7,4 en el 2019 19 y a la mayor disponibilidad de quirófanos secundario a la cancelación de gran parte de la programación quirúrgica de cirugías no prioritarias.…”