Global Overview of the Management of Acute CHOLEcystitis during the COVID-19 Pandemic: The CHOLECOVID Study

ABSTRACT

Introduction: National guidance issued in response to COVID-19 resulted in adoption of non-surgical modes of treatment in emergency surgery, including acute cholecystitis (AC). The CHOLECOVID Study is the definitive global audit of the management and outcomes of AC during COVID19. Method(s) Patients >18 years with acute cholecystitis during two predefined 8-week time periods, pre-pandemic (P1, 12/09/19- 12/11/19) and during the pandemic (P2, 12/03/20-12/05/20), were included. The primary outcome was 30-day all-cause mortality. Secondary outcomes included severity of AC, radiological diagnostic modalities implemented, definitive management and pulmonary complications. Result(s) 9,783 patients were included from 40 countries. 30-day mortality was higher in P2 (1.7%vs2.4%;p<0.015). Higher rates of moderate and severe AC were seen in P2 (30.1%vs35.1%, p<0.001;3.7%vs4.1%, p<0.001). First-line CT imaging was more common in P2 (36.3%vs46.3%;p<0.001). Cholecystostomy rates were higher in P2 (5.8%vs8.8%;p<0.001), with a reduction in cholecystectomy (23.4% vs 44.2%, p<0.001). Overall 4.6% (n=193) of P2 patients were COVID-19 positive, with overall mortality of 0.7% (n=30). Following adjustment using a natural effects mediation analysis, a diagnosis of acute cholecystitis during the pandemic was associated with almost 30% higher odds of death compared to the pre-pandemic. Conclusion(s) During the COVID-19 pandemic, a small increase in mortality among AC patients was noted, when compared to the pre-pandemic cohort. Patients during the COVID-19 pandemic presented with more severe AC, resulting in altered trends in diagnosis and management. Clear pathways are required to prevent disruption of services and safely manage AC moving forward, in the face of the ongoing COVID-19 pandemic. Copyright © 2022