Colorectal surgery during pandemic linked to worse outcomes in COVID-19 negative patients
Worse outcomes were seen in COVID-19 negative patients who underwent elective colorectal surgery during the pandemic, according to a study published in Journal of Gastrointestinal Surgery.
“Many elective operations were canceled early in the COVID-19 pandemic in order to conserve resources and to keep patients out of public settings,” Sarah B. Stringfield, from the department of surgery, Baylor University Medical Center, and colleagues wrote. “Our institution canceled elective cases except those that were considered ‘“medically necessary to correct a serious medical condition or to preserve the life of a patient.’” For colorectal patients, this included emergencies and selected cases such as cancer resections. We noticed that a high number of patients that underwent surgery during this time developed postoperative ileus (POI) and had a prolonged hospital stay. Our hypothesis was that patients undergoing surgery during the pandemic had worse short-term outcomes, despite being COVID-negative.
Stringfield and colleagues performed a retrospective study of COVID-19 negative patients who underwent elective abdominal colorectal surgery at Baylor University Medical Center in Dallas, Texas. They divided patients into groups including those who underwent surgery early in the pandemic when elective cases were canceled (3/16/2020–5/3/2020), the first month after resumption of elective cases (5/4–31/2020) and a control group of patients who underwent surgery 1 year prior (3/1/2019–4/30/2019). Investigators reported that elective cases performed in 2020 were case-matched to those in 2019 based on age, sex and operation type.
There were differences in sex, indication for surgery and operative time among patients. Investigators noted differences in nasogastric tube insertion and need for postoperative total parenteral nutrition, which increased time to a solid diet and length of stay. The March to April 2020 group had the highest rates of these outcomes, according to researchers.
Stringfield and colleagues said in patients who underwent surgery in March through April 2020, there continued to be statistically higher rates of need for postoperative total parenteral nutrition, nasogastric tube insertion and length of stay. There was no longer a significant difference in time to tolerating a diet.
“When elective cases were canceled early in the pandemic, COVID-19 negative patients that underwent surgery had higher rates of [postoperative ileus (POI)],” the investigators wrote. “We believe a large factor in the worse outcomes is a reflection of poor adherence to Enhanced Recovery After Surgery (ERAS) protocols. From March to May, the ERAS coordinator could not provide in-person education to patients.”
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