Teo Zhe Hao Timothy, Huey Cheong Wei Terence, Low Jee Keem, Junnarkar Sameer Padmakumar, Shelat Vishalkumar G
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Hepatopancreatobiliary Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
JMIR Perioper Med. 2022 May 23;5(1):e29045. doi: 10.2196/29045.
At the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice.
The aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit's elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume.
We performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265).
The elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01).
The reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic.
Chinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x.
在新冠疫情高峰期，由于医疗资源的配给，肝胆胰（HPB）科室不得不重新规划其手术量。我们报告一项本地审计，评估新冠疫情对HPB科室及HPB外科肿瘤学实践的影响。
本研究的目的是回顾新冠疫情对HPB科室择期和急诊手术病例的影响。次要目的是调查对HPB外科肿瘤手术量的影响。
我们对2019年1月至6月（基线期）和2020年（新冠疫情期）HPB科室的手术量进行了对比审计。对在全身麻醉下进行的择期和急诊病例进行审计。择期病例包括疝气和胆囊手术以及肝脏和胰腺切除术。急诊病例包括因普通外科指征进行的胆囊切除术和剖腹手术。我们排除了在内镜检查和局部麻醉下进行的操作。比较了两个时间段收集的回顾性数据。本研究已在中国临床试验注册中心注册（注册号：ChiCTR2000040265）。
在新冠疫情期间，择期手术量下降了41.8%（2019年为351例，2020年为204例）。疝气手术数量下降了63.9%（2019年为155例，2020年为56例；P<0.001），胆囊切除术下降了40.1%（2019年为157例，2020年为94例；P=0.83）。肝脏和胰腺切除术的数量分别增加了16.7%（2019年为30例，2020年为35例；P=0.004）和111.1%（2019年为9例，2020年为19例；P=0.001）。急诊手术工作量下降了40.9%（2019年为193例，2020年为114例）。急诊工作量下降最显著的是在3月（从41例降至23例，下降43.9%；P=0.94）、4月（从35例降至8例，下降77.1%；P=0.01）和5月（从32例降至14例，下降56.3%；P=0.39）；然而，只有4月的工作量下降具有统计学意义（P=0.01）。
由于新冠疫情导致的资源重新分配并未对HPB择期肿瘤学工作产生不利影响。通过采取谨慎措施，在疫情期间可以维持基本的手术服务。
中国临床试验注册中心（ChiCTR2000040265）；https://tinyurl.com/ms9kpr6x 。
