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. 2023 Nov 23;8(3):450-463.
doi: 10.1002/ags3.12758. eCollection 2024 May.

Effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation: A nationwide study in Japan based on the National Clinical Database

Shimpei Ogawa  1   2 , Hideki Endo  3 , Masahiro Yoshida  1   4 , Tomomitsu Tsuru  1   5 , Michio Itabashi  1   2 , Hiroyuki Yamamoto  3 , Yoshihiro Kakeji  6   7 , Hideki Ueno  6   8 , Yuko Kitagawa  9   10 , Taizo Hibi  11   12 , Akinobu Taketomi  11   13 , Norihiko Ikeda  11   14 , Masaki Mori  11   15
Affiliations

Effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation: A nationwide study in Japan based on the National Clinical Database

Shimpei Ogawa et al. Ann Gastroenterol Surg. .

Abstract

Aim: Possible negative effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation in Japan were examined in this study.

Methods: The National Clinical Database (NCD) is a large-scale database including more than 95% of surgical cases in Japan. We analyzed 13 107 cases of colorectal perforation from 2019 to 2021. National data were analyzed, and subgroup analyses were conducted for subjects in prefectures with high infection levels (HILs) and metropolitan areas (Tokyo Met. and Osaka Pref.). Postoperative 30-day mortality, surgical mortality, and postoperative complications (Clavien-Dindo grade ≥3) were examined. Months were considered to have significantly high or low mortality or complication rates, if the 95% confidence interval (CI) of the standardized mortality (morbidity) ratio (SMR) does not contain 1.

Results: In the NCD, postoperative 30-day mortality occurred in 1371 subjects (10.5%), surgical mortality in 1805 (13.8%), and postoperative complications in 3950 (30.1%). Significantly higher SMRs were found for 30-day mortality in November 2020 (14.6%, 1.39 [95% CI: 1.04-1.83]) and February 2021 (14.6%, 1.48 [95% CI: 1.10-1.96]), and for postoperative complications in June 2020 (37.3%, 1.28 [95% CI: 1.08-1.52]) and November 2020 (36.4%, 1.21 [95% CI: 1.01-1.44]). The SMRs for surgical mortality were not significantly high in any month. In prefectures with HILs and large metropolitan areas, there were few months with significantly higher SMRs.

Conclusions: The COVID-19 pandemic had limited negative effects on postoperative outcomes in patients with colorectal perforation. These findings suggest that the emergency system for colorectal perforation in Japan was generally maintained during the pandemic.

Keywords: COVID‐19; National Clinical Database; colorectal perforation; postoperative short‐term outcomes.

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Conflict of interest statement

Hideki Endo and Hiroyuki Yamamoto are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Intuitive Surgical Sarl, Johnson & Johnson K.K., and Nipro Co. Yuko Kitagawa is Editor‐in‐Chief of Annals of Gastroenterological Surgery. Masaki Mori is Emeritus Editor‐in‐Chief of Annals of Gastroenterological Surgery. Yoshihiro Kakeji and Hideki Ueno are Associate Editors of Annals of Gastroenterological Surgery dealing with the lower digestive tract. The other authors declare no conflicts of interest for this article.

Figures

FIGURE 1
FIGURE 1
Flowchart of the patient selection process.
FIGURE 2
FIGURE 2
Standardized mortality (morbidity) ratio (SMR) by month for all subjects. (A) Top: 30‐day mortality and number of patients. Bottom: SMR and expected mortality. → indicates months when the SMR was significantly higher. (B) Top: surgical mortality and number of patients. Bottom: SMR and expected mortality. (C) Top: postoperative complications (Clavien–Dindo classification grade ≥3) and number of patients. Bottom: SMR and expected morbidity. → indicates months when the SMR was significantly higher.
FIGURE 3
FIGURE 3
Standardized mortality (morbidity) ratio (SMR) by month for prefectures with high infection levels. (A) Top: 30‐day mortality and number of patients. Bottom: SMR and expected mortality. (B) Top: surgical mortality and number of patients. Bottom: SMR and expected mortality. (C) Top: postoperative complications (Clavien–Dindo classification grade ≥3) and number of patients. Bottom: SMR and expected morbidity. → indicates months when the SMR was significantly higher.
FIGURE 4
FIGURE 4
Standardized mortality (morbidity) ratio (SMR) by month for prefectures without high infection levels. (A) Top: 30‐day mortality and number of patients. Bottom: SMR and expected mortality. → indicates months when the SMR was significantly higher. (B) Top: surgical mortality and number of patients. Bottom: SMR and expected mortality. → indicates months when the SMR was significantly higher. (C) Top: postoperative complications (Clavien–Dindo classification grade ≥3) and number of patients. Bottom: SMR and expected morbidity.
FIGURE 5
FIGURE 5
Standardized mortality (morbidity) ratio (SMR) by month for Tokyo Met. and Osaka Pref. (A) Top: 30‐day mortality and number of patients. Bottom: SMR and expected mortality. (B) Top: surgical mortality and number of patients. Bottom: SMR and expected mortality. (C) Top: postoperative complications (Clavien–Dindo classification grade ≥3) and number of patients. Bottom: SMR and expected morbidity.
FIGURE 6
FIGURE 6
Standardized mortality (morbidity) ratio (SMR) by month for prefectures other than Tokyo Met. and Osaka Pref. (A) Top: 30‐day mortality and number of patients. Bottom: SMR and expected mortality. → indicates months when the SMR was significantly higher. (B) Top: surgical mortality and number of patients. Bottom: SMR and expected mortality. → indicates months when the SMR was significantly higher. (C) Top: postoperative complications (Clavien–Dindo classification grade ≥3) and number of patients. Bottom: SMR and expected morbidity. → indicates months when the SMR was significantly higher.
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References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. - PMC - PubMed
    1. Liu Q, Xin R, Zhao Y, Yu M, Jin C, Shou S, et al. Dynamic changes of emergency visits: a retrospective observational study. BMC Emerg Med. 2022;22(1):105. - PMC - PubMed
    1. Fedewa SA, Star J, Bandi P, Minihan A, Han X, Yabroff KR, et al. Changes in cancer screening in the US during the COVID‐19 pandemic. JAMA Netw Open. 2022;5(6):e2215490. - PMC - PubMed
    1. Okuno T, Takada D, Shin JH, Morishita T, Itoshima H, Kunisawa S, et al. Surgical volume reduction and the announcement of triage during the 1st wave of the COVID‐19 pandemic in Japan: a cohort study using an interrupted time series analysis. Surg Today. 2021;51(11):1843–1850. - PMC - PubMed
    1. Ikeda N, Yamamoto H, Taketomi A, Hibi T, Ono M, Niikura N, et al. The impact of COVID‐19 on surgical procedures in Japan: analysis of data from the National Clinical Database. Surg Today. 2022;52(1):22–35. - PMC - PubMed