The Impact of the COVID-19 Pandemic on Liver Surgery in South Wales

Abstract

Introduction: As the COVID-19 pandemic continues, it is increasingly apparent that the victims of the pandemic are not just those who contract the virus, but also the innumerable patients with other life limiting conditions who have had access to potentially life-saving surgery delayed due to lack of inpatient beds. Like many, our hospital initially cancelled all elective surgery but was able to re-instate it relatively quickly owing to the development of a “green pathway.” We sought to review how the pandemic has impacted hepatobiliary surgery at our unit. Methods: Our prospectively maintained database was interrogated to identify all surgical activity in our unit during 2019 (pre-COVID) and 2020 (COVID). Results: Our green pathway involves patients isolating for 14 days prior to admission to a separate ward with dedicated junior doctors who do not see non-green patients. Between January 1st and December 31st 2020, 129 patients underwent exploration with a view to liver resection. 106 resections were undertaken. This compares to 152 explorations with 123 resections in 2019. In 2020, our median length of stay was 6 days (1-41). Twelve patients (9%) developed a significant (CD 3 or 4) complication. There was no inpatient mortality. Median length of stay in 2019 was also 6 days (1-69). Twelve patients (8%) had significant morbidity. A single patient died (0.7%) Conclusion: In spite of the COVID pandemic, our unit has managed to continue to offer a high volume tertiary hepatobiliary surgical service without an increase in length of stay, morbidity or mortality.