Laparoscopic cholecystectomy during the COVID-19 pandemic in a tertiary care hospital in Germany: higher rates of acute and gangrenous cholecystitis in elderly patients

Abstract

Background The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany. Patients and methods We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year. Results A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the “pandemic subgroup”. Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality. Conclusion Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.

Die Auswirkungen der COVID-19 Pandemie führten zu signifikanten Veränderungen der Operations- und Liegezeiten bei Patienten nach Cholezystektomie

“…Rahimi et al. [ 13 ] konnten an 182 Patienten präsentieren, dass die histologische Untersuchung von Gallenblasen bei älteren Patienten während der COVID-19-Pandemie mehr akute und gangränöse Befunde aufwiesen. Dass der Schweregrad der Erkrankung im Rahmen der COVID-19-Pandemie angestiegen ist, wird von Koch et al.…”

“…Im Gegenteil, die postoperative Komplikationsrate fiel in der Gruppe Cov19 eher ab (Daten nicht gezeigt). Die Beobachtung, dass auch ältere Patienten während der COVID-19-Pandemie öfter mit schweren Verläufen zur Operation kamen, wurde in anderen Untersuchungen bestätigt [ 6 , 13 ].…”

“…Die Operations-, Krankenhausverweildauer und der klinischeVerlauf der Patienten unterschieden sich in dieser Analyse nicht signifikant zu den Vorjahreszeiträumen. Rahimi et al [13] Abb. 1 Die Anzahl der Langlieger (mehr als 4 Tage KrVD nach CHE, .…”

Prospective study on planned biliary stent placement to treat small common bile duct stones

“…Although cholecystectomy is recommended after endoscopic papillotomy for common bile duct stones concomitant with gallbladder stones, biliary complications have been reported to occur as frequently as approximately 20% while waiting for cholecystectomy 7 . Therefore, early cholecystectomy is preferable, but laparoscopic cholecystectomy often requires a waiting period of several weeks for treatment due to patient preference, lack of surgeons, COVID‐19 pandemic, and other factors 8,9 …”

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

“…During the COVID-19 pandemic, we observed an increased number of AC patients who presented with gangrenous acute cholecystitis. An early case series showed that COVID-19 infection and pneumonia were associated with GC with increased morbidity and mortality, mainly in elderly and frail patients [5][6][7][8][9].…”