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Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Care | Research

The influence of the COVID-19 pandemic on surgical therapy and care: a cross-sectional study

Authors: Karl H. Hillebrandt, Simon Moosburner, Axel Winter, Nora Nevermann, Nathanael Raschzok, Thomas Malinka, Igor M. Sauer, Moritz Schmelzle, Johann Pratschke, Sascha Chopra

Published in: BMC Surgery | Issue 1/2022

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Abstract

Background

Due to the COVID-19 pandemic, an extensive reorganisation of healthcare resources was necessary—with a particular impact on surgical care across all disciplines. However, the direct and indirect consequences of this redistribution of resources on surgical therapy and care are largely unknown.

Methods

We analysed our prospectively collected standardised digital quality management document for all surgical cases in 2020 and compared them to the years 2018 and 2019. Periods with high COVID-19 burdens were compared with the reference periods in 2018 and 2019.

Results

From 2018 to 2020, 10,723 patients underwent surgical treatment at our centres. We observed a decrease in treated patients and a change in the overall patient health status. Patient age and length of hospital stay increased during the COVID-19 pandemic (p = 0.004 and p = 0.002). Furthermore, the distribution of indications for surgical treatment changed in favour of oncological cases and less elective cases such as hernia repairs (p < 0.001). Postoperative thromboembolic and pulmonary complications increased slightly during the COVID-19 pandemic. There were slight differences for postoperative overall complications according to Clavien-Dindo, with a significant increase of postoperative mortality (p = 0.01).

Conclusion

During the COVID-19 pandemic we did not see an increase in the occurrence, or the severity of postoperative complications. Despite a slightly higher rate of mortality and specific complications being more prevalent, the biggest change was in indication for surgery, resulting in a higher proportion of older and sicker patients with corresponding comorbidities. Further research is warranted to analyse how this changed demographic will influence long-term patient care.
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Literature
1.
go back to reference Babidge WJ, Tivey DR, Kovoor JG, Weidenbach K, Collinson TG, Hewett PJ, Hugh TJ, Padbury RTA, Hill NM, Maddern GJ. Surgery triage during the COVID-19 pandemic. ANZ J Surg. 2020;90(9):1558–65.CrossRef Babidge WJ, Tivey DR, Kovoor JG, Weidenbach K, Collinson TG, Hewett PJ, Hugh TJ, Padbury RTA, Hill NM, Maddern GJ. Surgery triage during the COVID-19 pandemic. ANZ J Surg. 2020;90(9):1558–65.CrossRef
6.
go back to reference Prachand VN, Milner R, Angelos P, Posner MC, Fung JJ, Agrawal N, Jeevanandam V, Matthews JB. Medically necessary, time-sensitive procedures: scoring system to ethically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. J Am Coll Surg. 2020;231(2):281–8.CrossRef Prachand VN, Milner R, Angelos P, Posner MC, Fung JJ, Agrawal N, Jeevanandam V, Matthews JB. Medically necessary, time-sensitive procedures: scoring system to ethically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. J Am Coll Surg. 2020;231(2):281–8.CrossRef
7.
go back to reference Nevermann NF, Hillebrandt KH, Knitter S, Ritschl PV, Krenzien F, Benzing C, Bahra M, Biebl M, Sauer IM, Ollinger R, et al. COVID-19 pandemic: implications on the surgical treatment of gastrointestinal and hepatopancreatobiliary tumours in Europe. Br J Surg. 2020;107(9):e301–2.CrossRef Nevermann NF, Hillebrandt KH, Knitter S, Ritschl PV, Krenzien F, Benzing C, Bahra M, Biebl M, Sauer IM, Ollinger R, et al. COVID-19 pandemic: implications on the surgical treatment of gastrointestinal and hepatopancreatobiliary tumours in Europe. Br J Surg. 2020;107(9):e301–2.CrossRef
8.
go back to reference Collaborative CO. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396(10243):27–38.CrossRef Collaborative CO. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396(10243):27–38.CrossRef
9.
go back to reference Lobo D, Devys JM. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2022;77(1):110.CrossRef Lobo D, Devys JM. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2022;77(1):110.CrossRef
10.
go back to reference Filipe M, de Bock E, Geitenbeek R, Boerma D, Pronk A, Heikens J, Richir M. Impact of the COVID-19 pandemic on surgical colorectal cancer care in The Netherlands: a multicenter retrospective cohort study. J Gastrointest Surg. 2021;25(11):2948–50.CrossRef Filipe M, de Bock E, Geitenbeek R, Boerma D, Pronk A, Heikens J, Richir M. Impact of the COVID-19 pandemic on surgical colorectal cancer care in The Netherlands: a multicenter retrospective cohort study. J Gastrointest Surg. 2021;25(11):2948–50.CrossRef
11.
go back to reference Filipe MD, van Deukeren D, Kip M, Doeksen A, Pronk A, Verheijen PM, Heikens JT, Witkamp AJ, Richir MC. Effect of the COVID-19 pandemic on surgical breast cancer care in The Netherlands: a multicenter retrospective cohort study. Clin Breast Cancer. 2020;20(6):454–61.CrossRef Filipe MD, van Deukeren D, Kip M, Doeksen A, Pronk A, Verheijen PM, Heikens JT, Witkamp AJ, Richir MC. Effect of the COVID-19 pandemic on surgical breast cancer care in The Netherlands: a multicenter retrospective cohort study. Clin Breast Cancer. 2020;20(6):454–61.CrossRef
12.
go back to reference Rottoli M, Pellino G, Spinelli A, Flacco ME, Manzoli L, Morino M, Pucciarelli S, Jovine E, Abu Hilal Md, Rosati R et al. Impact of COVID-19 on the oncological outcomes of colorectal cancer surgery in northern Italy in 2019 and 2020: multicentre comparative cohort study. BJS Open. 2022; 6(1). Rottoli M, Pellino G, Spinelli A, Flacco ME, Manzoli L, Morino M, Pucciarelli S, Jovine E, Abu Hilal Md, Rosati R et al. Impact of COVID-19 on the oncological outcomes of colorectal cancer surgery in northern Italy in 2019 and 2020: multicentre comparative cohort study. BJS Open. 2022; 6(1).
13.
go back to reference Simmen H-P, Golinelli D, Sanmarchi F, Capodici A, Gribaudo G, Altini M, Rosa S, Esposito F, Fantini MP, Lenzi J. Variations of the quality of care during the COVID-19 pandemic affected the mortality rate of non-COVID-19 patients with hip fracture. PloS One. 2022; 17(2). Simmen H-P, Golinelli D, Sanmarchi F, Capodici A, Gribaudo G, Altini M, Rosa S, Esposito F, Fantini MP, Lenzi J. Variations of the quality of care during the COVID-19 pandemic affected the mortality rate of non-COVID-19 patients with hip fracture. PloS One. 2022; 17(2).
14.
go back to reference Winter A, Maurer MM, Schmelzle M, Malinka T, Biebl M, Fikatas P, Kroll D, Sauer IM, Hippler-Benscheidt M, Pratschke J et al. Digital documentation of complications in visceral surgery: possibilities and evaluation of an instrument for quality management. Chirurg. 2021. Winter A, Maurer MM, Schmelzle M, Malinka T, Biebl M, Fikatas P, Kroll D, Sauer IM, Hippler-Benscheidt M, Pratschke J et al. Digital documentation of complications in visceral surgery: possibilities and evaluation of an instrument for quality management. Chirurg. 2021.
15.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef
17.
go back to reference Baum P, Diers J, Lichthardt S, Kastner C, Schlegel N, Germer C-T, Wiegering A. Mortality and complications following visceral surgery. Deutsches Ärzteblatt Int. 2019. Baum P, Diers J, Lichthardt S, Kastner C, Schlegel N, Germer C-T, Wiegering A. Mortality and complications following visceral surgery. Deutsches Ärzteblatt Int. 2019.
18.
go back to reference McLean RC, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, Chowdhury S, Baker EA, Etherson KJ. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? Int J Surg. 2020;83:259–66.CrossRef McLean RC, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, Chowdhury S, Baker EA, Etherson KJ. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? Int J Surg. 2020;83:259–66.CrossRef
19.
go back to reference Cassidy MR, Rosenkranz P, McAneny D. Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. J Am Coll Surg. 2014;218(6):1095–104.CrossRef Cassidy MR, Rosenkranz P, McAneny D. Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. J Am Coll Surg. 2014;218(6):1095–104.CrossRef
20.
go back to reference Schreuder AM, Eskes AM, van Langen RGM, van Dieren S, Nieveen van Dijkum EJM. Active involvement of family members in postoperative care after esophageal or pancreatic resection: a feasibility study. Surgery. 2019;166(5):769–77.CrossRef Schreuder AM, Eskes AM, van Langen RGM, van Dieren S, Nieveen van Dijkum EJM. Active involvement of family members in postoperative care after esophageal or pancreatic resection: a feasibility study. Surgery. 2019;166(5):769–77.CrossRef
21.
go back to reference Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317–34.CrossRef Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317–34.CrossRef
22.
go back to reference Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Nguyen NT, Stamos MJ. A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. J Gastrointest Surg. 2014;18(12):2169–77.CrossRef Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Nguyen NT, Stamos MJ. A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. J Gastrointest Surg. 2014;18(12):2169–77.CrossRef
23.
go back to reference Alizadeh RF, Sujatha-Bhaskar S, Li S, Stamos MJ, Nguyen NT. Venous thromboembolism in common laparoscopic abdominal surgical operations. Am J Surg. 2017;214(6):1127–32.CrossRef Alizadeh RF, Sujatha-Bhaskar S, Li S, Stamos MJ, Nguyen NT. Venous thromboembolism in common laparoscopic abdominal surgical operations. Am J Surg. 2017;214(6):1127–32.CrossRef
24.
go back to reference Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217–22.CrossRef Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217–22.CrossRef
25.
go back to reference Glasbey JC, Nepogodiev D, Simoes JFF, Omar OM, Venn ML, Evans JP, Futaba K, Knowles CH, Minaya-Bravo A, Mohan H, et al. Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic. Colorectal Dis. 2020;23(3):732–49. Glasbey JC, Nepogodiev D, Simoes JFF, Omar OM, Venn ML, Evans JP, Futaba K, Knowles CH, Minaya-Bravo A, Mohan H, et al. Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic. Colorectal Dis. 2020;23(3):732–49.
26.
go back to reference Lock JF, Ungeheuer L, Borst P, Swol J, Löb S, Brede EM, Röder D, Lengenfelder B, Sauer K, Germer CT. Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery. Perioperative Med. 2020; 9(1). Lock JF, Ungeheuer L, Borst P, Swol J, Löb S, Brede EM, Röder D, Lengenfelder B, Sauer K, Germer CT. Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery. Perioperative Med. 2020; 9(1).
27.
go back to reference Danziger-Isakov L, Blumberg EA, Manuel O, Sester M. Impact of COVID-19 in solid organ transplant recipients. Am J Transplant. 2021;21(3):925–37.CrossRef Danziger-Isakov L, Blumberg EA, Manuel O, Sester M. Impact of COVID-19 in solid organ transplant recipients. Am J Transplant. 2021;21(3):925–37.CrossRef
Metadata
Title
The influence of the COVID-19 pandemic on surgical therapy and care: a cross-sectional study
Authors
Karl H. Hillebrandt
Simon Moosburner
Axel Winter
Nora Nevermann
Nathanael Raschzok
Thomas Malinka
Igor M. Sauer
Moritz Schmelzle
Johann Pratschke
Sascha Chopra
Publication date
01-12-2022
Publisher
BioMed Central
Keywords
Care
COVID-19
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01708-7

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