ABSTRACT
Purpose/Background: The COVID-19 pandemic resulted in major disruptions in surgical care due to limited resources and concerns over in-hospital transmission. Temporary pauses in elective colonoscopies delayed diagnosis for many colorectal diseases. It is unclear how these delays impacted colorectal surgical care. Hypothesis/Aim: We aim to examine changes in patterns of colorectal surgical care during the COVID-19 pandemic. Methods/Interventions: We performed a single-institution retrospective observational study including six surgeons examining changes in the relative proportions of procedures performed for three major surgical disease categories: colorectal cancer, diverticulitis, and inflammatory bowel disease (IBD). We examined case volumes across three large affiliated hospitals from January 1, 2019 to December 31, 2020. Trends in surgical case volume for patients with colorectal cancer, diverticulitis, and IBD were compared. We then examined trends in monthly mean follow-up time measured in days between time of surgical referral to time of surgery. Results/Outcome(s): Our study identified 956 colorectal surgeries over the 2-year period. There were more total procedures done in 2019 relative to 2020 (520 vs 436). Following March 2020, monthly surgical case volume decreased, driven primarily by decreases in diverticulitis and IBD case volume. Trends in cancer case volume remained relatively unchanged throughout the pandemic. See Figure 1. We noted no rise in emergent colorectal surgery case volume. On average, there were 6 emergent cases per month compared to 4 cases per month in the six months before and after March 2020. Average wait time to surgery increased from 77 days to 114 days in the six months immediately before and after March 2020 driven primarily by rectal cancer patients receiving neoadjuvant chemoradiation. Pre-pandemic wait times ranged from 39 days for colon cancer patients to 236 days for rectal cancer patients receiving neoadjuvant therapy. Postpandemic, average wait times ranged from 57 days for colon cancer patients to 282 days for rectal cancer patients requiring neoadjuvant therapy. Limitations: This is a single-institution case series which limits generalizability. However, given the increased availability in resources at a major academic institution, the shifts and potential delays in surgical care noted in this study may be greater at smaller hospitals. Conclusions/Discussion: Surgical case volume decreased following the pandemic, driven primarily by decreases in cases for IBD and diverticulitis. Despite these changes, we noted no large rise in the rates of emergent colorectal surgery suggesting the potential success of medical management of diverticulitis and IBD. Examination of outpatient wait time revealed a rise in the average wait time to surgery. This data may be helpful in better understanding the potential future surgical needs of a large population of patients whose care was deferred during the pandemic.