Ann Surg Treat Res.  2022 Aug;103(2):104-111. 10.4174/astr.2022.103.2.104.

The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study

• Okuyan G
• Yıldırım M

• KMID: 2532365
• DOI: http://doi.org/10.4174/astr.2022.103.2.104

Abstract

Purpose
The objective of this study is to evaluate the effect of the coronavirus disease 2019 (COVID-19) pandemic on elective and emergent colorectal surgical practice.
Methods
The population of this retrospective observational study consisted of all consecutive patients who underwent emergent or elective colorectal surgery between March 2019 and March 2021. The patients were divided into 2 groups: the prepandemic group who were treated between March 2019 and March 10, 2020, and the pandemic group who were treated between March 11, 2020 and March 2021. The rate of emergent operations was the primary outcome. The groups were compared based on the frequency of operations, distribution of tumoral features in malignant cases, and 90th-day mortality rates.
Results
There were 180 and 121 patients in the prepandemic and pandemic groups, respectively. There were significantly more patients of the American Society of Anesthesiologists physical status stage IV with comorbidity in the pandemic group than in the prepandemic group (P = 0.016 and P < 0.001, respectively). The rate of emergent operations was significantly higher in the pandemic group than in the prepandemic group (49.6% vs. 26.7%, P < 0.001). There were significantly more patients who received non-resectional surgery in the pandemic group than in the prepandemic group (P = 0.002). Additionally, there were significantly more patients without resection among patients with a defunctioning stoma (P = 0.001). The length of hospital stay (LoS) was significantly shorter in the pandemic group than in the prepandemic group (P = 0.039). On the other hand, the mortality rate was significantly higher in the pandemic group than in the prepandemic group (15.7% vs. 6.1%, P = 0.011).
Conclusion
The study findings suggested that the COVID-19 pandemic adversely affected colorectal surgical practices, resulting in more frequent emergent operations, non-resectional procedures with stoma formation, and higher mortality rates.

Keyword

Colorectal surgery; COVID-19; Morbidity; Mortality

Reference

1. Uyan M, Özdemir A, Kalcan S, Tomas K, Demiral G, Pergel A, et al. Effects of COVID-19 pandemic on colorectal cancer surgery. Sao Paulo Med J. 2022; 140:244–249. PMID: 34586288.

2. Lui T, Leung K, Guo CG, Tsui V, Wu JT, Leung WK. Impacts of the coronavirus 2019 pandemic on gastrointestinal endoscopy volume and diagnosis of gastric and colorectal cancers: a population-based study. Gastroenterology. 2020; 159:1164–1166. PMID: 32425228.

3. D’Ovidio V, Lucidi C, Bruno G, Lisi D, Miglioresi L, Bazuro ME. Impact of COVID-19 pandemic on colorectal cancer screening program. Clin Colorectal Cancer. 2021; 20:e5–e11. PMID: 32868231.

4. Choi JY, Park IJ, Lee HG, Cho E, Kim YI, Kim CW, et al. Impact of the COVID-19 pandemic on surgical treatment patterns for colorectal cancer in a tertiary medical facility in Korea. Cancers (Basel). 2021; 13:2221. PMID: 34066390.

5. De Vincentiis L, Carr RA, Mariani MP, Ferrara G. Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018-2019: an audit study from cellular pathology. J Clin Pathol. 2021; 74:187–189. PMID: 32561524.

6. Boyle JM, Kuryba A, Blake HA, Aggarwal A, van der Meulen J, Walker K, et al. The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: a national survey. Colorectal Dis. 2021; 23:1733–1744. PMID: 33686679.

7. Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020; 21:1023–1034. PMID: 32702310.

8. Ministry of Health, Republic of Turkey (MoH-TR). COVID-19 web page of the Republic of Turkey [Internet]. Ankara: MoH-TR;2020. cited 2021 Dec 20. Available from: https://covid19.saglik.gov.tr/TR-66494/pandemi.html .

9. Kuryba A, Boyle JM, Blake HA, Aggarwal A, van der Meulen J, Braun M, et al. Surgical treatment and outcomes of colorectal cancer patients during the COVID-19 pandemic: a national population-based study in England. Ann Surg Open. 2021; 2:e071. PMID: 34240077.

10. Xu Y, Huang ZH, Zheng CZ, Li C, Zhang YQ, Guo TA, et al. The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study. BMC Gastroenterol. 2021; 21:185. PMID: 33879095.

11. Foo FJ, Ho L, Tan WJ, Koh FH, Sivarajah SS, Park SY, et al. Colorectal cancer surgery in Asia during the COVID-19 pandemic: a tale of 3 cities. Asian J Surg. 2022; 45:1095–1100. PMID: 34483046.

12. de la Portilla de Juan F, Reyes Díaz ML, Ramallo Solía I. Impact of the pandemic on surgical activity in colorectal cancer in Spain. Results of a national survey. Cir Esp (Engl Ed). 2021; 99:500–505. PMID: 34210653.

13. Shinkwin M, Silva L, Vogel I, Reeves N, Cornish J, Horwood J, et al. COVID-19 and the emergency presentation of colorectal cancer. Colorectal Dis. 2021; 23:2014–2019. PMID: 33793063.

14. World Health Organization (WHO). WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. Geneva: WHO;2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 .

15. Tong GJ, Zhang GY, Liu J, Zheng ZZ, Chen Y, Niu PP, et al. Comparison of the eighth version of the American Joint Committee on Cancer manual to the seventh version for colorectal cancer: a retrospective review of our data. World J Clin Oncol. 2018; 9:148–161. PMID: 30425940.

16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213. PMID: 15273542.

17. Smith HG, Jensen KK, Jørgensen LN, Krarup PM. Impact of the COVID-19 pandemic on the management of colorectal cancer in Denmark. BJS Open. 2021; 5:zrab108. PMID: 34755189.

18. Polson R, Abdelqader B, Chung WY, Sangal S. Impact of the COVID-19 pandemic on early outcomes after colorectal cancer surgery. Br J Surg. 2021; 108:e398–e399. PMID: 34672322.

19. Donlon NE, Hayes C, Davern M, Bolger JC, Irwin SC, Butt WT, et al. Impact of COVID-19 on the diagnosis and surgical treatment of colorectal cancer: a national perspective. Dis Colon Rectum. 2021; 64:1305–1309. PMID: 34623346.

20. Rashid MU, Raza SS, Thomas P, Vakis S. Comparison of colorectal cancer surgery services during COVID-19 first wave with pre-COVID time. Cureus. 2021; 13:e17585. PMID: 34522556.

21. Sobrado LF, Nahas C, Marques C, Cotti G, Imperiale AR, Averbach P, et al. Is it safe to perform elective colorectal surgical procedures during the COVID-19 pandemic? A single institution experience with 103 patients. Clinics (Sao Paulo). 2021; 76:e2507. PMID: 33787677.

22. Morris E, Goldacre R, Spata E, Mafham M, Finan PJ, Shelton J, et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. Lancet Gastroenterol Hepatol. 2021; 6:199–208. PMID: 33453763.

23. Manlubatan S, Lopez M, Onglao M, Monroy Iii HJ. Modifications to treatment plan of rectal cancer in response to COVID-19 at the Philippine general hospital. Ann Coloproctol. 2021; 37:225–231. PMID: 34364319.

24. Peltrini R, Imperatore N, Di Nuzzo MM, D’Ambra M, Bracale U, Corcione F. Effects of the first and second wave of the COVID-19 pandemic on patients with colorectal cancer: what has really changed in the outcomes? Br J Surg. 2021; 108:e365–e366. PMID: 34476460.

25. Lim JH, Lee WY, Yun SH, Kim HC, Cho YB, Huh JW, et al. Has the COVID-19 pandemic caused upshifting in colorectal cancer stage? Ann Coloproctol. 2021; 37:253–258. PMID: 34376026.

26. Tschann P, Girotti P, Lechner D, Adler S, Feurstein B, Szeverinski P, et al. How does the COVID-19 pandemic influence surgical case load and histological outcome for colorectal cancer? A single-centre experience. J Gastrointest Surg. 2021; 25:2957–2960. PMID: 33852126.

27. Kim CW, Lee SH. Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea. Ann Surg Treat Res. 2021; 101:240–246. PMID: 34692596.