Impact of COVID-19 Pandemic on Management of Acute Cholecystitis in Singapore

Abstract

Letter to the Editor Dear Editor, The COVID-19 pandemic has brought about profound challenges in Singapore 1 with surgery drawing scrutiny due to the need to conserve personal protection equipment (PPE), ventilators, intensive care unit (ICU) beds as well as concerns of concurrent COVID-19 infection in surgical patients with reported mortality rate of up to 20%. 2 Given the scarcity of resources and risks associated with concurrent COVID-19 infection in the surgical patient, international guidelines have recommended medical treatment for acute issues related to cholelithiasis that are normally treated surgically. 3 This stance has implications on the management of acute cholecystitis (AC) with meta-analyses demonstrating conclusive benefits of index admission early laparoscopic cholecystectomy (ELC) over interval delayed laparoscopic cholecystectomy (DLC) that include decreased total length of stay, decreased readmission for persistent pain and gallstone-related morbidity, earlier return to work, improved quality of life and increased cost-effectiveness. 4,5 The need to balance the surgical risk and resource considerations of acute cholecystitis with the obligations of delivering optimal outcomes and avoiding morbidity thus poses an ethical dilemma during this pandemic. With the rapidly evolving pandemic coupled with different subspecialty surgeons managing AC in Singapore, opinions and practices may inevitably vary among institutions and surgeons. Resource and manpower constraints would also translate to changing practices on the ground. Thus, the aim of this study is to evaluate the impact of COVID-19 on the management of AC in Singapore. An anonymous online survey was developed and disseminated across all seven public restructured hospitals in Singapore in April 2020 via electronic mail. Inclusion criteria was consultant specialist surgeons who perform laparoscopic cholecystectomy in Singapore. The survey was administered through an online platform, Google Forms (Google LLC, Menlo Park, California, USA). The survey includes questions on demographics of survey respondents, impact of the

Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study

“…Recommendations were made for postponing elective surgical cases where possible [ 27 ]. Locally, there was a shift toward nonoperative management for stable, benign conditions such as uncomplicated acute cholecystitis [ 28 ]. This was to redirect resources toward the management of patients with COVID-19.…”

One Year on: An Overview of Singapore’s Response to COVID-19—What We Did, How We Fared, How We Can Move Forward

“…They explored areas such as the reduction in respiratory infections [365,[368][369][370][371]374,375,379,380], stroke admissions [376,377], increase in the door-to-balloon time for percutaneous coronary intervention [358], and the impact on the care of patients with dementia [362,364]. Several articles were about surgical specialties [381][382][383][384][385][386][387], such as the management of cholecystitis [382], the outcomes in pregnant women infected with COVID-19 [384], and the decrease in hip fractures [385]. The impact on conditions related to other specialties [388][389][390][391][392][393] was also described, such as the reduction in the number of patients seen at the emergency department [394], the epidemiological trends in Kawasaki disease [389], and the management of patients with chronic pain [395].…”

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department

“…15 A study has reported the challenges and dilemmas in AC management during the CO-VID-19 pandemic in Singapore; however, the study was limited to opinions of surgeons by survey without clinical outcomes. 16 Studies from the United States and Ireland have shown a reduced number of AC cases during the pandemic and have discussed the severity of the disease. 17,18 Thus, we designed a study to investigate the impact of COVID-19 on patients with AGD who visited an emergency room (ER) and underwent emergency cholecystec-tomy in Korea.…”

“…Furthermore, LC is indicated in COVID-19-positive patients for which medical treatment or interventional management is ineffective [ 15 ]. A study has reported the challenges and dilemmas in AC management during the COVID-19 pandemic in Singapore; however, the study was limited to opinions of surgeons by survey without clinical outcomes [ 16 ]. Studies from the United States and Ireland have shown a reduced number of AC cases during the pandemic and have discussed the severity of the disease [ 17 , 18 ].…”