Samantha Olafson, MD
Surgical Resident
Einstein Healthcare Network, United States
Disclosure information not submitted.
Mark Kaplan, MD
Chair of Trauma and Surgical Critical Care
Einstein Medical Center Philadelphia, United States
Disclosure information not submitted.
Benjamin Moran, MD
Assistant Professor of Surgery
Albert Einstein Medical Center, United States
Disclosure information not submitted.
Jay Strain, MD, FACS
Assistant Professor of Surgery
Einstein Healthcare Network, United States
Disclosure information not submitted.
Afshin Parsikia, MD, MPH
Director of Surgical Research
Einstein Healthcare Network, United States
Disclosure information not submitted.
Pak Shan Leung, MD, MS, FACS
Associate Chair of Trauma and Surgical Critical Care
Einstein Medical Center Philadelphia, United States
Disclosure information not submitted.
Title: Laparoscopic Cholecystectomy in the Time of Coronavirus: A Level 1 Trauma Center’s Experience
Introduction: With the rise of the COVID-19 pandemic, it is important to understand the unforeseen hurdles that may be incurred on the healthcare system. Laparoscopic cholecystectomy (LC), one of the most common surgical procedures performed in the U.S., offers a window into the effects of the pandemic on routine surgical care. We hypothesized that limited resources during the COVID-19 pandemic would have negatively impacted hospital efficiency in dealing with common surgical problems. 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 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. To chart the performance rate of LC, we used 4 sequential temporal phases based on statewide incidence data on COVID-19: pre-pandemic, 1st peak, recovery, and 2nd peak. We calculated the performance rate of LC at each phase, measured in number of cases per day. In a separate analysis, we divided the patients into pre-pandemic and intra-pandemic groups. The intra-pandemic group included all patients in the 1st peak, recovery, and 2nd peak. We compared the groups based on baseline characteristics and outcomes.
RESULTS :The performance rate of LC through each phase varied as follows: pre-pandemic 0.61, 1st peak 0.34, recovery 0.44, 2nd peak 0.53. Compared to the pre-pandemic group, the intra-pandemic group had a higher incidence of complicated gallbladder disease (P < .05). Baseline characteristics, pre-surgical wait-time, complications, and length of stay, were not significantly different between the pre-pandemic and intra-pandemic groups.
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 group implies patient hesitancy to seek routine surgical care. Better preparation could allocate resources in a proactive fashion to prevent such a marked decrease in performance rate and optimize the subsequent recovery. In preparation for future pandemics, hospitals should invest resources and strategies to ensure efficiency and reinforce a safe environment that minimizes patient hesitancy.