Impact of COVID-19 lockdown on in-hospital mortality and surgical activity in elective digestive resections. A nationwide cohort analysis

Challine, A.; Dousset, B.; de’Angelis, N.; Lefèvre, J.H.; Parc, Y.; Katsahian, S.; Lazzati, A.

BACKGROUND: The outbreak of COVID-19 infection has led to the reorganization of hospital care in several countries. The objective was to report the postoperative mortality after elective digestive resections in a nationwide cohort during the lockdown period. METHOD: This is analytic study was performed using a national billing database (PMSI). Patients who underwent elective digestive resections were divided in two group: the lockdown group defined by hospital admissions between March 17(th) and May 11(th) 2020; and the control group, defined by hospital admissions during the corresponding period in 2019. Groups were matched on propensity score, geographical region, and surgical procedure. The primary outcome was the postoperative mortality. RESULTS: The overall population included 15,217 patients, 9325 patients in the control group and 5892 in the lockdown group. The overall surgical activity was decreased by 37% during the lockdown period. The overall in-hospital mortality during the hospital stay was 2.7%. After matching and adjustment, no difference in mortality between groups was reported (OR=1.05; 95%CI: 0.83–1.34; p=0.669). An asymptomatic COVID-19 infection was a risk factor for a twofold increased mortality whereas a symptomatic COVID-19 infection was associated with a tenfold increased mortality. CONCLUSIONS: Despite a considerable reduction in the surgical activity for elective digestive resections during the lockdown period, mortality remained stable on a nationwide scale in COVID-free patients. These findings support that systematic SARS-CoV-2 screening should be advocated prior to elective gastrointestinal surgery and that all efforts should be made to maintain elective surgical resection for cancer during the second wave in COVID-free patients.