Laparoscopic Cholecystectomy in the Time of Coronavirus: A Level-1 Trauma Center's Experience

Am Surg. 2023 Nov;89(11):4632-4639. doi: 10.1177/00031348221121552. Epub 2022 Sep 7.

Abstract

Introduction: Laparoscopic cholecystectomy (LC), one of the most common surgical procedures performed in the U.S., offers a window into the effects of the COVID-19 pandemic on routine surgical care. The purpose of our study was to analyze the effects of the COVID-19 pandemic at a Level-1 trauma center on the performance rate of non-elective LC over time.

Methods: A retrospective chart review from July 2019 to December 2020 identified all non-elective LC cases performed at a level-1 trauma center. Patients were categorized into 4 temporal phases along the course of the pandemic based on statewide incidence data on COVID-19: pre-pandemic, peak 1, recovery, and peak 2. We compared the phases based on demographic information and outcomes.

Results: In total, 176 patients were reviewed. The performance rate in cases/day varied as follows: pre-pandemic .61, 1st peak .34, recovery .44, and 2nd peak .53. The complication rate was highest in the 2nd peak (16%) (P < .05). Compared to the pre-pandemic period, the intra-pandemic period had a higher incidence of complicated gallbladder disease (P < .05). In the non-elderly subgroup, complicated gallbladder disease was significantly more prevalent in the intra-pandemic period compared to the pre-pandemic period (25% vs 10%, P < .05).

Conclusions: Our data suggests a learning curve throughout the course of the pandemic, reflecting a stepwise increase in the performance rate of LC. The higher incidence of complicated gallbladder disease in the intra-pandemic period may imply patient hesitancy to seek routine surgical care, especially among younger patients.

Keywords: COVID-19; acute care surgery; cholecystectomy; coronavirus; general surgery.

MeSH terms

  • COVID-19* / epidemiology
  • Cholecystectomy, Laparoscopic* / adverse effects
  • Gallbladder Diseases* / etiology
  • Gallbladder Diseases* / surgery
  • Humans
  • Middle Aged
  • Pandemics
  • Retrospective Studies
  • Trauma Centers