A comparison of outcomes following laparoscopic cholecystectomies before and after COVID using objective scoring systems.

Abstract

Introduction: There is an almost universal perception that following the COVID-19 disruption laparoscopic cholecystectomies (LCs) have become more technically demanding, resulting in poorer outcomes. This study quantifies the differences in outcomes before and after the pandemic.

Methods: Elective LCs performed by two upper gastrointestinal surgeons in the same hospital between January and December 2019 (pre-COVID group) and between September 2021 and August 2022 (post-COVID group) were included. LCs on the emergency list and those that included common bile duct exploration were excluded. Demographics, American Society of Anesthesiologists' grade, indications, waiting times, operative times, Nassar score, Parkland grade and outcome measures were collected. An online calculator for social science statistics was used to analyse the data.

Results: In the pre-COVID group, a lower proportion of patients underwent cholecystectomy for previous cholecystitis (pre-COVID 13.04% vs post-COVID 35.7%; p < 0.001), and LCs were shorter (pre-COVID 74min vs post-COVID 85min; p = 0.018). The mean Nassar score and Parkland grade in the pre-COVID group (Nassar = 4.03, Parkland = 1.8) were less than in the post-COVID group (Nassar =5.41, Parkland = 2.5; p < 0.001 and p = 0.006). Other than a higher rate of subtotal cholecystectomies (5.4% pre-COVID vs 12.2% post-COVID; p = 0.04), there were no significant differences in outcomes.

Conclusion: This study demonstrates that a larger proportion of LCs were performed for patients with a history of cholecystitis, and LCs were indeed challenging. There were no significant differences in outcome, apart from the rates of subtotal cholecystectomy. These data should inform the debate about early LCs following index admission.