How has the management of acute Biliary pathology changed as a result of the SARS COV2 pandemic?

ABSTRACT

Aims: Gallbladder pathology is a common cause of Emergency admission under General surgery-however management had to be drastically changed given The unexpected pressures of The SARS-CoV-2 pandemic. This study aimed to compare management strategies in patients presenting with Biliary pathology pre and intra-SARS-CoV-2 pandemic in one NHS truSt. Method(s) A database of patients admitted to The acute surgical admissions ward in The months of November 2019 and 2021 was accessed, patients with Biliary presentations were isolated and information about these admissions analysed. Result(s) In 2019 4 of 57 (8.7%) of patients admitted with Biliary pathology had a laparoscopic cholecystectomy during that acute admission, compared to 8 of 65 (12.3%) in 2021. For all interventions (including ERCp and cholecystostomy) these values were 14 of 57 (25%) in 2019 and 24 of 65 (37%) in 2021. of 54 patients in 2019 who did not have laparoscopic cholecystectomy on index admission, 9 were readmitted (16.7%). The median duration of admission for all Biliary patients on index admission was 4 days in 2019 compared to 5.9 days in 2021. Conclusion(s) SARS COV2 has precipitated a change in management of acute Biliary patients. There is now an increased rate of intervention during The index admission and subsequent increase in admission duration. This is seen as an improvement in The pathway for patients in The long term, reducing The burden on The elective waiting list and reducing re-admission which will of fset The modest increase in length of stay on The index admission.