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Multicenter Study
. 2022 Jan;15(1):128-136.
doi: 10.1111/ases.12980. Epub 2021 Sep 1.

Effect of the COVID-19 Pandemic on the Management of Acute Cholecystitis and Assessment of the Crisis Approach: A Multicenter Experience in Egypt

Mina M B Fouad  1 , Samuel S S Rezk  1 , Arsany T Saber  1 , Ahmed Khalifa  1 , Peter Ibraheim  2 , Sandy M N Ibraheim  1
Affiliations
Multicenter Study

Effect of the COVID-19 Pandemic on the Management of Acute Cholecystitis and Assessment of the Crisis Approach: A Multicenter Experience in Egypt

Mina M B Fouad et al. Asian J Endosc Surg. 2022 Jan.

Abstract

Introduction: The covid-19 pandemic has had a drastic impact on all medical services. Acute cholecystitis is a serious condition that accounts for a considerable percentage of general surgical acute admissions. Therefore, the Royal College of Surgeons' Commissioning guidance' recommended urgent admission to secondary care and early cholecystectomy. During the first wave of hospital admissions associated with COVID-19, most guidelines recommended conservative treatment in order to limit the admission rates and free up spaces for COVID-19-infected patients. However, reviews of this approach have not been widely done to assess the results and, in turn, planning our future management approach when future pressures on in-patient admissions are inevitable.

Methods: Our study included all acute cholecystitis patients who needed surgical intervention in one Centre in the UK over three distinct periods (pre-COVID-19, during the first lockdown, and lockdown ease). Comparison between these groups were done regarding intraoperative and postoperative results.

Results: The conservative management led to a high rate of readmission. Moreover, delayed cholecystectomy was associated with increased operative difficulties such as extensive adhesions, intraoperative blood loss, and/or complicated gall bladder pathologies such as perforated or gangrenous gall bladder (29.9%, 16.7%, and 24.8%, respectively). The resulting postoperative complications of surgical and nonsurgical resulted in a longer hospital stay (13.5 d).

Conclusion: The crisis approach for acute cholecystitis management failed to deliver the hoped outcome. Instead, it backfired and did the exact opposite, leading to longer hospital stays and extra burden to the patient and the healthcare system.

Keywords: COVID-19; acute cholecystitis; crisis approach.

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Conflict of interest statement

The authors do not have conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The treatment strategies for acute cholecystitis before and after the rise of the COVID‐19 pandemic in Egypt. Patients were deemed unfit for surgery after strict cardiopulmonary, anesthetic assessment, and calculation of the surgical risk through NELA, P‐possum scores and assessment of the functional capacity of each patient. Uncontrolled sepsis means persistent fever plus right upper quadrant pain and positive Murphy sign despite using antibiotics plus or minus tachycardia and/or hypotension
FIGURE 2
FIGURE 2
Changes in the numbers of monthly performed laparoscopic cholecystectomy (LC) in relation to rise in of COVID‐related hospital admissions. As shown in the figure, after the start of the pandemic in the middle of March, the monthly number of performed laparoscopic cholecystectomy plummeted as a result of the crisis protocol (average number of monthly performed LC was 51). Failure of conservative management resulted in a rise in the number of emergency laparoscopic cholecystectomies (average number of monthly performed LC was 25). The average number of hospitalized COVID‐19 patients secondary to COVID‐related complication was 5093 patients monthly. Note that the number of hospitalized COVID‐19 patients on chart is multiplied by 100
See this image and copyright information in PMC

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