The impact of the Covid-19 on resectional colorectal surgery - A systematic review and meta-analysis

ABSTRACT

Aim: To quantify the impact of the pandemic on colectomy rates and compare post-operative outcomes to pre-pandemic levels. Method(s) A systematic review was conducted as per the PRISMA statement. We interrogated, MEDLINE, EMBASE, the Cochrane library and Web of Science for studies focusing on colorectal resections in adults and/or their outcomes during the Covid-19 pandemic. Studies not reporting a pre-pandemic comparison were excluded. Meta analyses were performed on STATA using a random effects model. Heterogeneity was assessed using the I2 statistic. Result(s) 1976 articles were identified and after removing duplicates and screening full text articles, 19 met the inclusion criteria from 11 countries with one multi-national cohort. A total of 30354 patients were included in this study, 18856 pre-pandemic and 11498 in the pandemic. In total 18 studies reported pre and post-pandemic resection numbers. There was a mean reduction of 22.3% in colorectal resections overall comparing pre and pandemic periods. 10 studies reported on elective colorectal cancer resections, with a mean reduction of 27.9% during the pandemic period. Only 3 studies reported cases of elective benign colectomies, with a mean reduction of 49.1% during the pandemic period. On meta-analysis the overall 30 day mortality risk comparing the pre and pandemic period was not significantly different (RR1.29 95% c.i. 0.88 - 1.87, p = 0.124). We found no statistically significant differences in readmission within 30days, use of laparoscopic surgery or stoma formation between the pre and pandemic periods. Conclusion(s) There was a reduction in the number of colectomies performed world-wide. Despite pressures on resources and national guidelines deviating from best practice, post-operative outcomes appear not to be significantly affected. This analysis may be limited by inadequate powering or misrepresentative sampling. Further work may interrogate national databases to accurately describe resectional colorectal surgery during the pandemic.