ABSTRACT
Purpose/Background: During the early phases of the COVID-19 pandemic, elective surgery was halted in Texas in accordance with the Governor's executive order. Emergency and cancer operations were still allowed and performed at our institution. Our hypothesis was that Covid negative patients undergoing surgery during this time period have worse short term outcomes. We set out to identify rates of Postoperative Ileus (POI) and Length Of Stay (LOS) in patients that underwent surgery during the pandemic and compare them to patients operated upon prior to the pandemic and after elective cases resumed. Methods/Interventions: This is a retrospective review of COVIDnegative patients undergoing colorectal surgery at Baylor University Medical Center in Dallas, TX, during the pandemic. They were divided into those that underwent surgery during the early phases of the pandemic (3/16-5/3/2020) and the first month after resumption of elective cases (5/4-31/2020). Control group included patients that underwent surgery 1 year prior (3/1-4/30/2019). Results/Outcome(s): Nineteen patients underwent surgery in March/ April 2020 and 41 underwent surgery in May 2020. In March-April 2019, 112 cases were performed. Patient characteristics and types of cases are listed in Table 1. In March/April 2020, there were significantly more patients with cancer and a greater proportion were male. These patients had significantly higher rates of postoperative nasogastric tube (NGT) insertion (42.1%) than in May 2020 (12.2%) or Mar/April 2019 (5.4%, p<0.001), and longer LOS (4.9d v 3.8 v 3.6, p=0.045). When comparing only patients that underwent elective surgery, there continued to be differences in NGT insertion rates (54.5% in MarApr20 v 12.1% in May20 v 4.8% in MarApr19, p<0.001), need for postoperative TPN (18.2% v 3% v 0%, p<0.001), resulting in longer time to tolerating a solid diet (3.7d v 1.8 v 1.7, p=0.034) and longer LOS (5.0d v 3.0 v 3.0, p=0.027). There was no significant difference in readmission rate or rate of other postoperative complications. These findings continued to be significant on a matched analysis of elective cases. Conclusions/Discussion: During the early phase of the pandemic, patients had higher rates of POI resulting in NGT placement, TPN, and increased LOS. We believe this is predominantly a reflection of poor adherence to ERAS protocols. Our ERAS inpatient coordinator was not able to provide education, patients did not walk outside of their rooms, and were not cared for by dedicated colorectal nursing staff as our floor became a COVID containment unit. In addition, there was likely an element of psychological stress related to needing hospitalization during the pandemic that contributed to delayed return of bowel function. This study demonstrates the importance of adherence to an ERAS protocol in patient outcomes, and the overall adverse impact the COVID pandemic has had on patient care.