COVID-19 大流行对胆囊结石手术管理的影响：一项瑞典基于人群的研究。
Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study.
机构信息
Department of Clinical Science and Education, Södersjukhuset Karolinska Institute Stockholm Sweden.
Department of Surgery, Mora Hospital, Mora, Sweden.
出版信息
Scand J Surg. 2022 Jan-Mar;111(1):14574969211070389. doi: 10.1177/14574969211070389.
BACKGROUND
The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice.
METHODS
The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions.
RESULTS
Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 ( = 0.113). The ratio of procedures on patients aged <65 years was 0.945 ( = 0.008), on patients aged 65-80 years was 0.964 ( = 0.423), on patients aged >80 years was 1.336 ( = 0.025), on men was 1.001 ( = 0.841), on women was 0.934 ( = 0.006), on procedures completed laparoscopically was 0.964 ( = 0.190), on procedures completed with open approach was 0.659 ( = 0.044), on acute procedures was 1.218 ( = 0.016), on planned procedures was 0.791 ( < 0.001), on procedures performed for biliary colic was 0.808 ( < 0.001), on procedures performed for acute cholecystitis was 1.274 ( = 0.012), for biliary pancreatitis was 1.192 ( = 0.037), and for obstructive jaundice was 1.366 ( = 0.008).
CONCLUSIONS
The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a continuation of a long-term trend toward more acute surgery remains unanswered. Further studies are needed to assess and evaluate how this has affected public health and health economics.
背景
SARS-CoV-2 大流行对医疗保健服务的提供产生了重大影响。随着资源的重新分配，胆囊结石等良性疾病的手术往往被置于次要地位。我们不知道这对患有单纯性胆囊结石病的患者发展为急性胆囊炎、胆源性胰腺炎或梗阻性黄疸的风险有何影响。
方法
本研究基于基于人群的瑞典胆囊结石手术和内镜逆行胰胆管造影登记处。将 COVID-19 首次在瑞典出现之前的时间段（即 2015 年 4 月至 2020 年 3 月）与大流行期间的 2020 年 4 月至 2021 年 3 月的时间段进行比较。对可能与优先决策相关的因素进行分层。
结果
总共进行了 78211 例手术。在研究期间，2020 年 4 月至 2021 年 3 月期间进行的手术比例为 0.960（ = 0.113）。<65 岁患者的手术比例为 0.945（ = 0.008），65-80 岁患者为 0.964（ = 0.423），>80 岁患者为 1.336（ = 0.025），男性为 1.001（ = 0.841），女性为 0.934（ = 0.006），腹腔镜完成的手术比例为 0.964（ = 0.190），开腹完成的手术比例为 0.659（ = 0.044），急症手术比例为 1.218（ = 0.016），择期手术比例为 0.791（ < 0.001），用于治疗胆绞痛的手术比例为 0.808（ < 0.001），用于治疗急性胆囊炎的手术比例为 1.274（ = 0.012），用于治疗胆源性胰腺炎的手术比例为 1.192（ = 0.037），用于治疗梗阻性黄疸的手术比例为 1.366（ = 0.008）。
结论
COVID-19 对过去 2 年胆囊结石手术的组织方式产生了重大影响。计划手术数量的减少可能反映了大流行期间资源的重新分配。然而，急性手术数量的增加是计划手术的推迟还是急性手术长期趋势的延续，目前仍不得而知。需要进一步研究来评估和评估这对公共卫生和卫生经济学的影响。
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