The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study

Teo, Zhe Hao; Huey, Cheong Wei Terence; Low, Jee Keem; Junnarkar, Sameer P; Shelat, Vishal G

doi:10.2196/29045

Cited by 6 publications

(8 citation statements)

References 19 publications

(15 reference statements)

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“…Thus, knowledge of COVID-19 as an aetiology of AP is important as it stops the pursuit of aetiology identification, guides physician on the counselling of their patients, and impacts management decision for cholecystectomy. In patients with mild biliary pancreatitis, index admission laparoscopic cholecystectomy is considered good clinical practice while surgery should be delayed in patients with COVID-19 infection to minimize risk to healthcare workers and reduce patient morbidity[ 93 , 94 ]. Shao et al [ 95 ] analysed 589 patients with COVID-19 infection prior to surgery and concluded that postoperative mortality was nearly 6 times higher for patients infected with COVID-19 within 2 wk before surgery when adjusting for patient and procedure level factors[ 95 ].…”

Section: Discussionmentioning

confidence: 99%

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Teng¹,

Chua²,

Lim³

et al. 2023

World J Gastroenterol

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BACKGROUND Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP. AIM To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system. METHODS A systematic review was conducted on PubMed, World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021. Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection, age < 18 years old, review articles and retrospective cohort studies. The original 10-item Naranjo scoring system (total score 13) was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction. We modified the original scoring system into a 8-item modified Naranjo scoring system (total score 9) to determine the cause-effect relationship between COVID-19 and AP. A cumulative score was decided for each case presented in the included articles. Interpretation of the modified Naranjo scoring system is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable cause. RESULTS The initial search resulted in 909 articles, with 740 articles after removal of duplicates. A total of 67 articles were included in the final analysis, with 76 patients which had AP reported to be due to COVID-19. The mean age was 47.8 (range 18-94) years. Majority of patients (73.3%) had ≤ 7 d between onset of COVID-19 infection and diagnosis of AP. There were only 45 (59.2%) patients who had adequate investigations to rule out common aetiologies (gallstones, choledocholithiasis, alcohol, hypertriglyceridemia, hypercalcemia and trauma) of AP. Immunoglobulin G4 testing was conducted in 9 (13.5%) patients to rule out autoimmune AP. Only 5 (6.6%) patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum. None of the patients had other recently diagnosed viral infections apart from COVID-19 infection, or underwent genetic testing to rule out hereditary AP. There were 32 (42.1%), 39 (51.3%) and 5 (6.6%) patients with doubtful, possible, and probable cause-effect relationship respectively between COVID-19 and AP. CONCLUSION Current evidence is weak to establish a strong link between COVID-19 and AP. Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology.

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Section: Discussionmentioning

confidence: 99%

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Teng¹,

Chua²,

Lim³

et al. 2023

World J Gastroenterol

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“…The data from several studies provides evidence for the decrease in the number of surgeries for cholelithiasis during the COVID-19 pandemic. Teo et al (2022), conducted in Singapore, aimed to analyze the volume of surgical interventions in the specialized hepatobiliary department while comparing the periods from January to June of 2019 and 2020 (the first wave of COVID-19), the number of cholecystectomies decreased by 40.1%. Patel et al (2022) in a retrospective cohort study of adult patients presented to the emergency department with symptoms related to gallstone disease during the pandemic concluded that older patients with higher comorbidity presented with acute gallstone disease.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Management of gallstone disease and chronic liver diseases during the COVID-19 outbreak in Ukraine: an ecological study

Bogomaz,

Natrus,

Ziuz

et al. 2023

IJHG

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PurposeThe purpose of this paper is to estimate the possible impact of the COVID-19 pandemic on the hospitalization and hospital mortality of the patients with gallstone disease and chronic liver diseases (CLD) in the worst pandemic period in Ukraine.Design/methodology/approachA retrospective comparative analysis of annual reports data of all economy subjects, which conducted economic activity in medical practice for 2019 and 2021. Data was accepted from the Ministry of Health of Ukraine, the National Security and Defense Council of Ukraine (NSDC) and the State Statistics Service of Ukraine (SSSU).FindingsThe total hospitalization rates for diffuse liver disease and cholelithiasis significantly decreased during the peak of the COVID-19 pandemic in Ukraine, compared to the values of 2019. At the same time, the rates of in-hospital mortality for these diseases have significantly grown. Also, various proportions of similar trends were described in other countries during the first wave of the pandemic.Originality/valueThis paper highlights the fact that regulatory restrictions and the fear of the population of referring to healthcare facilities considering the high risk of getting an infection had significant disruption to medical care for patients with gallstone disease and CLD. Improving the management of medical resources and strengthening all kinds of institutions in the healthcare system must be thought about if similar challenges appear in the future.

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Section: Surgical Interventions For Covid-19-related Apmentioning

confidence: 99%

“…In response to the pandemic, many surgeries were postponed or canceled due to COVID-19, especially surgery for the pancreas[ 27 ]. Elective surgery decreased by 41.8% compared to 2019, including hernial surgery (63.9% decrement), cholecystectomy (40.1% decrement), liver surgery (16.7% decrement), and pancreatic surgery (111.1% decrement) in Singapore[ 27 ]. A study from ten Italian referral centers ( n = 1423) reported a 18.7% decrement in the surgical volume in 2020, with a 43.4% decrease in surgery for benign lesions and a decrease of 33.6% in operations for neuroendocrine tumors[ 28 ].…”

Section: Surgical Interventions For Covid-19-related Apmentioning

confidence: 99%

Surgical intervention for acute pancreatitis in the COVID-19 era

Su¹,

Chen²

2022

World J Clin Cases

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Approximately 15%-19% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. Acute pancreatitis (AP) has been reported in 0.1% of patients with coronavirus disease 2019 (COVID-19). Biliary AP was most common (78.4%) before the COVID-19 pandemic; idiopathic AP is most common in patients with COVID-19 (up to 57.1%). The number of emergency department presentations decreased by 23.3% during the pandemic and many governments made national recommendations to delay nonurgent endoscopic procedures, leading to decrements of 22% in combined esophagogastroduodenoscopy (EGD) and colonoscopy and 20% in EGD after the COVID-19 pandemic. The symptoms and signs of COVID-19-related AP are fever (63%), abdominal pain (58%), respiratory symptoms (40%), nausea and vomiting (39%), and headache (4%). Approximately 5-10% of patients develop necrotizing or hemorrhagic AP, and patients who required surgical intervention had a higher mortality risk. Compared to 2019, the rates of elective surgery decreased by 41.8% in 2020; including cholecystectomy (40.1% decrease) and pancreas (111.1% decrease). Surgical volumes also decreased by 18.7% in 2020; device-assisted laparoscopic and robot-assisted procedures reduced by 45.4% and 61.9% during the COVID-19 Lockdown in 2020.

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The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study

Cited by 6 publications

References 19 publications

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Management of gallstone disease and chronic liver diseases during the COVID-19 outbreak in Ukraine: an ecological study

Surgical intervention for acute pancreatitis in the COVID-19 era

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