COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Abstract

Background Acute cholecystitis is a common reason for emergency general surgery admission. The declaration of the COVID-19 pandemic may have resulted in treatment delays and corresponding increases in severity of disease. This study compared cholecystitis admissions and disease severity pre- and post-declaration of pandemic. Materials and Methods Retrospective review of adult acute cholecystitis admissions (1/1/20-5/31/20). Corresponding time periods in 2018 and 2019 comprised the historical control. Difference-in-differences analysis compared biweekly cholecystitis admissions pre- and post-declaration in 2020 to the historical control. Odds of increased severity of disease presentation were assessed using multivariable logistic regression. Results Cholecystitis admissions decreased 48.7% from 5.2 to 2.67 cases [RR 0.51(0.28,0.96), p=0.04] following pandemic declaration when comparing 2020 to historical control (p=0.02). After stratifying by severity, only Tokyo I admissions declined significantly post-declaration [RR 0.42(0.18,0.97)], when compared to historical control (p=0.02). There was no change in odds of presenting with severe disease after the pandemic declaration [aOR 1.00 (95% CI 0.30, 3.38) p<0.99] despite significantly longer lengths of symptoms reported in mild cases. Conclusion Post-pandemic declaration we experienced a significant decrease in cholecystitis admissions without corresponding increases in disease severity. The pandemic impacted healthcare-seeking behaviors, with fewer mild presentations. Given that the pandemic did not increase odds of presenting with increased severity of disease, our data suggests that not all mild cases of cholecystitis progress to worsening disease and some may resolve without medical or surgical intervention.

Management of Symptomatic Gallstone Disease during COVID-19 Lockdown in a High-Resource Setting: Is There a Need for Treatment Alterations?

“…Most nonacute CCEs were performed in patients who were previously treated for CDL and had nonbearable pain spells or suspicion for malignancy. While Vallès et al [27] reported a decrease in Grad I (mild) cholecystitis, we did not see a difference regarding overall caseload, timing of presentation, and severity of disease of our cholecystitis patients during the lockdown. The perception of the local hospital’s situation may have a hard-to-calculate influence on primary care physicians in their decision to admit a patient for surgery or treat medically.…”

“…They reported a decrease in admission for cholelithiasis during the early lockdown with an increase in admission for cholelithiasis between late May and the end of June 2020 [26]. Others have also reported reduced rates of cholecystitis during the lockdown [4, 27], which is interesting in light of increased weight gain [28, 29] and substance use during these time periods [30]. The south of Germany was hit hard and early by the pandemic.…”

“…While there was a low incidence during the summer, a second lockdown started on November 1 that lasted till January 15. While most authors reported a reduction in general surgery caseload [2, 26, 27], some also saw an increase [5]. This was attributed to the reluctancy of the general population to present to an emergency room with nonsevere symptoms and poses the risk of delayed proper care [26].…”

The Impact of COVID-19 Pandemic Upon Non-elective Admissions and Surgery at a Safety-Net Hospital

“…The one exception is the significantly higher percentage of SSI during the COVID time period, the reasons for which are unclear. A study at an urban, safety-net hospital in Boston also observed a 49% decrease in admissions for cholecystitis 27 . However, when stratified by severity, only admissions for Tokyo I mild cholecystitis declined significantly 27 .…”

“…However, when stratified by severity, only admissions for Tokyo I mild cholecystitis declined significantly 27 . The authors concluded that not all cases of acute cholecystitis progress to more severe disease and some mild cases resolve with outpatient antibiotics or symptomatic treatment 27 .…”