BN SO08 - A Comparison of outcomes following Laparoscopic Cholecystectomies before and after COVID-19

Abstract

Abstract Background The COVID-19 pandemic led to the suspension of elective surgeries between March 2020 and March 2021 in the NHS and large parts of the world. In Prince Charles Hospital, elective services were phased in from April 2021 and elective laparoscopic cholecystectomies resumed in June 2021. There is an almost universal perception among surgeons that the cholecystectomies after covid disruption, have become more technically demanding, resulting in longer operative times and poorer outcomes. This study aims to quantify the differences in indications, CLOC score, Parkland grades, and outcomes, following elective cholecystectomy, one year before and after COVID Method Laparoscopic Cholecystectomies performed on elective lists between January 2019 and December 2019 by two UGI surgeons were included in the pre-COVID group. Cholecystectomies performed between September 2021 and August 2022 by the same UGI surgeons were included in the post-COVID group. Cholecystectomies on the CEPOD list and procedures which included CBD exploration or choledochoscopies were excluded. Demographics, ASA, indications, waiting times, operative times, CLOC and Parkland scores were collected. Outcome measures were complications, drains, hospital stay and proportion of subtotal colectomy, day case surgeries, and conversions to open. An online calculator for social science statistics was used to analyze data. Results The pre-covid(n=92) and post-covid(n=98) groups were comparable in age(P=.37), gender(P=.06) and ASA(P= .057). Pre Covid, lower Proportion of patients underwent cholecystectomy for previous cholecystitis(precovid 13.04%, post-covid 35.7%)(P<.001). Pre Covid Cholecystectomies were shorter(pre-covid 74 minutes, post-covid 85 minutes, P=.018). The mean CLOC score and Parkland grade in precovid group (CLOC= 4.03, Parkland 1.8) were less than in the postcovid group(mean CLOC=5.41, mean Parkland 2.5)( P<.001, P=.006). Apart from the Subtotal Cholecystectomy rate (5.4% pre-covid vs 12.2 postcovid, P=-04) and drains (P=.02), there were no significant differences in outcome measures. Conclusion This study demonstrares that the COVID disruption resulted in more challenging procedures, indicated by the increase in CLOC score, Parkland grade, and longer operating times. This is a reflection of a much larger proportion of surgeries being performed for previous cholecystitis. There are however no significant differences in outcome, except the higher rates of subtotal cholecystectomy. This suggests that the skills and techniques have compensated for higher difficulty levels. Data does show an approximately 15% difference between the groups in all other outcome measures which however does not reach statistical significance. A larger sample is needed to clarify this.