Impact of COVID-19 on volume of elective and nonelective ventral hernia repair

Michael Katzen¹, Sullivan Ayuso², Kyle Thompson³, Dau Ku⁴, Gregory Scarola⁵, Paul Colavita⁶, Vedra Augenstein⁷, B Todd Heniford⁸

Affiliations

¹ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/_MKatzen_.
² Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/SAyusoMD.
³ Carolinas Center for Surgical Outcomes Science, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC.
⁴ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
⁵ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/GregoryTScarola.
⁶ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/PDColavita.
⁷ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/VedraAugenstein.
⁸ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Todd.Heniford@gmail.com.

PMID: 36402608
PMCID: PMC9673035
DOI: 10.1016/j.surg.2022.09.039

Impact of COVID-19 on volume of elective and nonelective ventral hernia repair

Michael Katzen et al. Surgery. 2023 Feb.

. 2023 Feb;173(2):350-356.

doi: 10.1016/j.surg.2022.09.039. Epub 2022 Nov 16.

Authors

Michael Katzen¹, Sullivan Ayuso², Kyle Thompson³, Dau Ku⁴, Gregory Scarola⁵, Paul Colavita⁶, Vedra Augenstein⁷, B Todd Heniford⁸

Affiliations

¹ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/_MKatzen_.
² Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/SAyusoMD.
³ Carolinas Center for Surgical Outcomes Science, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC.
⁴ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
⁵ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/GregoryTScarola.
⁶ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/PDColavita.
⁷ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/VedraAugenstein.
⁸ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Todd.Heniford@gmail.com.

PMID: 36402608
PMCID: PMC9673035
DOI: 10.1016/j.surg.2022.09.039

Abstract

Background: The significant decrease in elective surgery during the COVID-19 pandemic prompted fears that there would be an increase in emergency or urgent operations for certain disease states. The impact of COVID-19 on ventral hernia repair is unknown. This study aimed to compare volumes of elective and nonelective ventral hernia repairs performed pre-COVID-19 with those performed during the COVID-19 pandemic.

Methods: An analysis of a prospective database from 8 hospitals capturing patient admissions with the International Classification of Diseases, Tenth Revision Procedure Coding System for ventral hernia repair from January 2017 through June 2021 were included. During, COVID-19 was defined as on or after March 2020.

Results: Comparing 3,558 ventral hernia repairs pre-COVID-19 with 1,228 during COVID-19, there was a significant decrease in the mean number of elective ventral hernia repairs per month during COVID-19 (pre-COVID-19: 61 ± 5 vs during COVID-19 19: 39 ± 11; P < .001), and this persisted after excluding the initial 3-month COVID-19 surge (61 ± 5 vs 42 ± 9; P < .001). There were fewer nonelective cases during the initial 3-month COVID-19 surge (32 ± 9 vs 24 ± 4; P = .031), but, excluding the initial surge, there was no difference in nonelective volume (32 ± 9 vs 33 ± 8; P = .560). During COVID-19, patients had lower rates of congestive heart failure (elective: 9.0% vs 6.6%; P = .0047; nonelective: 17.7% vs 11.6%; P < .001) and chronic obstructive pulmonary disease (elective: 13.7% vs 10.2%; P = .017; nonelective: 17.9% vs 12.0%; P < .001) and underwent fewer component separations (10.2% vs 6.4%; P ≤ .001). Intensive care unit admissions decreased for elective ventral hernia repairs (7.7% vs 5.0%; P = .016). Length of stay, cost, and readmission were similar between groups.

Conclusion: Elective ventral hernia repair volume decreased during COVID-19 whereas nonelective ventral hernia repairs transiently decreased before returning to baseline. During COVID-19, patients appeared to be lower risk and less complex. The possible impact of the more complex patients delaying surgery is yet to be seen.

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