COVID-19 对择期和非择期腹外疝修补术量的影响。
Impact of COVID-19 on volume of elective and nonelective ventral hernia repair.
机构信息
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/_MKatzen_.
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: http://www.twitter.com/SAyusoMD.
出版信息
Surgery. 2023 Feb;173(2):350-356. doi: 10.1016/j.surg.2022.09.039. Epub 2022 Nov 16.
BACKGROUND
The significant decrease in elective surgery during the COVID-19 pandemic prompted fears that there would be an increase in emergency or urgent operations for certain disease states. The impact of COVID-19 on ventral hernia repair is unknown. This study aimed to compare volumes of elective and nonelective ventral hernia repairs performed pre-COVID-19 with those performed during the COVID-19 pandemic.
METHODS
An analysis of a prospective database from 8 hospitals capturing patient admissions with the International Classification of Diseases, Tenth Revision Procedure Coding System for ventral hernia repair from January 2017 through June 2021 were included. During, COVID-19 was defined as on or after March 2020.
RESULTS
Comparing 3,558 ventral hernia repairs pre-COVID-19 with 1,228 during COVID-19, there was a significant decrease in the mean number of elective ventral hernia repairs per month during COVID-19 (pre-COVID-19: 61 ± 5 vs during COVID-19 19: 39 ± 11; P < .001), and this persisted after excluding the initial 3-month COVID-19 surge (61 ± 5 vs 42 ± 9; P < .001). There were fewer nonelective cases during the initial 3-month COVID-19 surge (32 ± 9 vs 24 ± 4; P = .031), but, excluding the initial surge, there was no difference in nonelective volume (32 ± 9 vs 33 ± 8; P = .560). During COVID-19, patients had lower rates of congestive heart failure (elective: 9.0% vs 6.6%; P = .0047; nonelective: 17.7% vs 11.6%; P < .001) and chronic obstructive pulmonary disease (elective: 13.7% vs 10.2%; P = .017; nonelective: 17.9% vs 12.0%; P < .001) and underwent fewer component separations (10.2% vs 6.4%; P ≤ .001). Intensive care unit admissions decreased for elective ventral hernia repairs (7.7% vs 5.0%; P = .016). Length of stay, cost, and readmission were similar between groups.
CONCLUSION
Elective ventral hernia repair volume decreased during COVID-19 whereas nonelective ventral hernia repairs transiently decreased before returning to baseline. During COVID-19, patients appeared to be lower risk and less complex. The possible impact of the more complex patients delaying surgery is yet to be seen.
背景
在 COVID-19 大流行期间，择期手术显著减少，人们担心某些疾病状态的急诊或紧急手术会增加。COVID-19 对腹疝修补术的影响尚不清楚。本研究旨在比较 COVID-19 前和 COVID-19 期间行择期和非择期腹疝修补术的数量。
方法
对 2017 年 1 月至 2021 年 6 月期间 8 家医院前瞻性数据库中以国际疾病分类第 10 次修订版手术操作编码系统为基础的腹疝修补术患者的住院情况进行了分析。COVID-19 期间定义为 2020 年 3 月或之后。
结果
与 COVID-19 前的 3558 例腹疝修补术相比，COVID-19 期间的 1228 例中有显著减少的平均每月择期腹疝修补术数量（COVID-19 前：61 ± 5 例 vs COVID-19 期间：39 ± 11 例；P<0.001），且这种情况在排除 COVID-19 最初 3 个月的激增后仍然存在（61 ± 5 例 vs 42 ± 9 例；P<0.001）。COVID-19 最初 3 个月的激增期间非择期病例较少（32 ± 9 例 vs 24 ± 4 例；P=0.031），但排除最初的激增后，非择期手术量无差异（32 ± 9 例 vs 33 ± 8 例；P=0.560）。COVID-19 期间，择期手术患者充血性心力衰竭发生率较低（9.0% vs 6.6%；P=0.0047；非择期手术：17.7% vs 11.6%；P<0.001）和慢性阻塞性肺疾病（择期手术：13.7% vs 10.2%；P=0.017；非择期手术：17.9% vs 12.0%；P<0.001），且更少行分离术（10.2% vs 6.4%；P ≤ 0.001）。择期腹疝修补术的 ICU 入院率降低（7.7% vs 5.0%；P=0.016）。两组的住院时间、费用和再入院率相似。
结论
COVID-19 期间择期腹疝修补术数量减少，而非择期腹疝修补术数量在最初减少后恢复到基线水平。COVID-19 期间，患者的风险似乎较低，病情也较简单。更复杂的患者推迟手术的可能影响还有待观察。
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