Impact of Pre-operative COVID-19 Diagnoses on Post-operative Outcomes in Laparoscopic Cholecystectomy: A Matched Cohort Analysis

Abstract

Introduction

Laparoscopic cholecystectomy is the standard treatment for gallbladder disease, but post-operative complications can vary based on patient comorbidities. Recent studies have highlighted the consequences of a COVID-19 diagnosis on procedures of multiple organ systems. The robust detrimental effects of COVID-19 continue to impact patient outcomes beyond respiratory-related procedures and extend to surgical procedures across various specialties. Findings have shown that a pre-operative COVID-19 diagnosis leads to an increase in surgical complications and post-operative recovery. However, the implications of a COVID-19 diagnosis for laparoscopic cholecystectomy complications and post-operative outcomes remain less understood. This study investigates the impact a COVID-19 diagnosis has on patients’ hospitalization duration, time to surgery, and post-operative outcomes.

Methods

The National Surgical Quality Improvement Program (NSQIP) database was used to analyze data from laparoscopic cholecystectomy procedures performed in participating hospitals between 2021 and 2022. A 1:2 propensity score matched group analysis was conducted to evaluate differences in post-operative complication rates, time to surgery, total operation time, and hospital length of stay between patients with and without a pre-operative COVID-19 diagnosis. Patients were categorized into two cohorts: those with a pre- operative COVID-19 diagnosis and those without. Patients with pre-existing severe comorbidities, severe pneumonia, hypercoagulability (or those on anticoagulant therapy), and those requiring an unplanned conversion from laparoscopic to open surgery were excluded from the analysis. Propensity scores were generated using logistic regression and modeled using demographic and pre- operative clinical features. Patient outcomes were assessed using GGE marginal models with matched groups as clusters and robust standard errors. GEE Link functions used were logit for binary outcomes and log for quantitative outcomes.

Results

A total of 2,583 patients who underwent laparoscopic cholecystectomy were analyzed, with 1,722 in the PreOp COVID-negative group and 861 in the PreOp COVID-positive group. Following propensity score matching, baseline characteristics were well-balanced between cohorts. Patients with pre-operative COVID-19 had a higher risk of post-operative complications (OR = 2.01, 95% CI: 1.45– 2.77, p < 0.001), with 8% experiencing complications compared to 4% in the non-COVID group. Time from admission to surgery was found to be significantly prolonged among PreOp COVID patients (1.61 days, 95%CI: 1.46-1.78 vs. 0.76 days, 95%CI: 0.70-0.84, p < 0.001). Additionally, they had a longer hospital stay (3.02 days, 95%CI: 2.77-3.28 vs. 1.53 days, 95%CI: 1.41-1.66, p < 0.001). Surgical duration was also significantly affected, with PreOp COVID patients requiring longer operative times (78.7 min, 95%CI:75.8- 81.6 vs. 68.89 min, 95%CI: 67.1-70.7, p < 0.001).

Conclusion

Pre-operative COVID-19 was associated with increased post-operative complications, increased time to surgery from admission, longer operative times, and prolonged hospital stays. These findings suggest that a history of pre-operative COVID-19 may impact surgical readiness and recovery, potentially leading to delays in care and adverse outcomes. Enhanced pre-operative screening and perioperative precautions may be warranted for patients with recent COVID-19 infections to improve post-operative outcomes.