Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

CHOLECOVID Collaborative

doi:10.1093/bjsopen/zrac052

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

BJS Open. 2022 May 2;6(3):zrac052. doi: 10.1093/bjsopen/zrac052.

Author

CHOLECOVID Collaborative^{1

2}

Collaborators

CHOLECOVID Collaborative:
H V M Spiers, O Kouli, W U-R Ahmed, R Varley, D Ahari, L Argus, K A McLean, S K Khamarahah, P Coe, E A Griffiths, A K C Chan, C Macutkiewicz, S Jamdar, M Wilson, C Fullwood, G Toogood, A K Siriwardena, A Gilchrist, M Goldsworthy, M Rashid, P Pockney, J Varela, N Brindl, J Ramirez, C Marafante, Y Iwao, A Ghzawi, M Elhadi, H Gacaferi, C Varghese, A Adeyeye, O Alser, C Teh, M Prieto, A Hasan, H Al-Naggar, R Salgado, F Veracierto, T Lancelotti, D Solinas, R Oddi, F W Garcia, E Mazza Diez, M R Andrade Ramirez, R Bracco, D Fernandez, M A Maraschio, L Obeide, E Giordano, A Alcaraz, M A Marani, N Aguirre, F Luna, M Francesconi, F Chiham, R Ramos Cossio, F A Alvarez, D A Pantoja Pachajoa, F Mandojana, I G Merlo, M H Gonzalez, G Cervelo, R Puma, G F Vardaro, A Davis, D Jurat, C Guenoff, K Raubenheimer, K Goddard, K Brown, K J Wegrecki, Hyc Cheung, M Yang, H Cheung, J Siddiqui, J H Ahn, R Huynh, Y H Lam, M Afzal, B S Ong, Mym Chua, K Ly, J E Thomson, D Watson, A C Dawson, A Drane, S Van Ruyven, Ewy Lun, P Pockney, M Ferguson, J Y Jeong, C De Silva, V Wills, J Gundara, E Mccourt, C Bong, R Tabone, W J Wong, A Gray, D Koh, M Pollock, S Singhal, R Smith, N N Dudi-Venkata, H Kanhere, C Stranz, W Seow, L T Mansour, J Wormald, Bpt Loveday, B Thomson, T O'Donnell, N Milenkovski, M Herath, M Trochsler, A Farfus, G Maddern, Z Bunjo, L L Kuan, G Atanasov, A Dawson, A Drane, S van Ruyven, E Lun, E Samadov, I Namazov, M Asgarov, A Ibrahimli, M Srinivasan, M F Saeed, H Aljawder, I Juma, F J Coimbra, N Marques, W A Casteleins, A Petruzziello, G Jabur, Jfp Rodriguez, P L Buso, S MacKenzie, M Hsiao, I Sljivic, A Tecson, P J Karanicolas, R Roke, J Moon, E V Butler, F Riquelme, M Yanez, F Catan, M Uribe, F Carriel, F Oppliger, A Paredes, D Daroch, J C Aguayo, C J Perez Rivera, L M Acosta Buitrago, A Kadamani Abiyomaa, M S Mosquera Paz, P Cabrera, J Corso, N Ozcay, A Ozant, K Arslan, H Besim, H Almezghwi, A Y Azzam, S Bessa, I El-Sayes, A Badawy, M Wael, A El-Gendi, M A Azab, M Fayed, M El Kassas, M Gamal, A Tawheed, A Al Shafie, S Emile, A Elfallal, H Elfeki, M Shalaby, A Sakr, M Elbahnasawy, M Shama, W Abdel-Elsalam, S Abd-Elsalam, J E Escobar Dominguez, F Medrano, S Gaitan, O M Escalon Gonzalez, J C Alfaro Varela, M Cea, M Interiano, B Cabrera, Z Lakkis, P Georges, C Antonot, J Magnin, C Kamphues, J C Lauscher, C Schineis, F N Loch, L D Lee, K Beyer, K Bouchagier, I Galanis, D Bartziotas, E Lostoridis, P Tourountzi, E A Nagorni, A Charalabopoulos, E Baili, E Kyros, I Vagios, A Skotsimara, T Liakakos, A Alexandrou, A Papalampros, V Papadopolous, A Tooulias, I Kentarchos, C Christou, G Tsoulfas, L F Tale-Rosales, I Lopez Muralles, H Melendez, G Bran, F A Monroy Mahecha, J R Contreras, D E Porras, E Paiz, E R Soto, J R Ixcayau Hernandez, A Gupta, D Rajput, N Kumar, R Mani, A A Sonkar, A Anand, M K Agrawal, K Gaurav, M Tripathi, S Sikora, K Bharathy, M Kumar Rangapa, D S Khuller, S K K, R Bhojwwani, S Ayy Ar, A Jain N Mehraj, F Hussain, I Nazir, M Shah, N A Chowdri, A Hilmi, G Argenio, P Atelli, E Palladino, M F Armellino, N Tamini, L C Nespoli, L Degrate, M Angrisani, F Carissimi, P Bordoni, F Fleres, P Bordoni, G Clarizia, A Spolini, M Franzini, E Cucinotta, G Badessi, C Mazzeo, F Viscosi, G Pintabona, T Campagnaro, E Poletto, G Turri, A Ruzzenente, S Conci, A Guglielmi, C Feo, N Fabbri, M Fazzin, S Giaccari, C V Feo, M Massani, P Pellizzo, M Colella, R Tutino, F Cappellacci, F Medas, G L Canu, E Erdas, P G Calò, A Porcu, T Perra, A M Scanu, C F Feo, A Fancellu, P Germani, C Giunta, A Biloslavo, H Abdallah, G Aizza, A Barberis, F Belli, M Santoliquido, M Filauro, G Canonico, T Nelli, C Di Martino, L Capezzuoli, A Anastasi, L Bressan, S Cortinovis, C Nagliati, F Colombo, L Ferrario, A Bondurri, C Guerci, A Maffioli, F Catena, G Perrone, M Giuffrida, A Morini, A Annicchiarico, G Gallo, A Carpino, F Ferrari, G De Paola, G Sammarco, C Callari, L Licari, V Sorce, D Di Miceli, F Lovisetto, S Zonta, F Lovisetto, A Chessa, A Fiorini, A De Manzoni Garberini, E Angelini, C Marafante, E Moggia, A Murgese, S Mungo, S L Birolo, M Garino, N S Federico, A Muratore, E G Lunghi, M Calabro, P Cianci, R Enrico, S Capuzzolo, L Cafagna, M Minafra, D Sasia, A Gattolin, M Migliore, R Rimonda, E Travaglio, G De Marco, C Elter, T Bargellini, S D'amico, D Zambonin, A Caponi, G Calini, A Puggioni, V Bresadola, T Zalla, S Cantafio, F Feroci, L Romoli, R Giudicissi, A Picciariello, V Papagni, R Dibra, A Picciariello, D F Altomare, E Pinotti, M Montuori, G Baronio, V Tonini, L Sartarelli, A Gori, M Cervellera, P Lapolla, P Sapienza, G Brachini, B Cirillo, M Zambon, A Mingoli, A Pascariello, L Boccia, S Benedetti, G Mantovani, M De Angelis, F Ferrara, V Testa, F Borghi, F Maione, V Pruiti Ciarello, G Giraudo, F Agresta, G Cestaro, D Prando, F Cavallo, M Zese, N Cillara, R Sechi, R Cardia, A Cannavera, G Putzu, F Frongia, A Pisanu, D Delogu, G Esposito, M Podda, A Iossa, F De Angelis, C Boru, G Silecchia, G M Palini, G Garulli, S Veneroni, P Tammaro, P Maida, P A Leake, M G Wanliss, Y Iwao, K Sato, N Chiyonobu, H Imamura, S Yamazaki, M Watanabe, A Qasem, F Ayasra, S Al Dahabrh, A Khaled, A Al-Thunaibat, D Olaywah, S Alqudah, S Alqawasmi, A Khamees, A Guboug, M Es Salim, T Althwabteh, H Bani Khaled, N El-Hammuri, A Aljesrawi, F Alamaadany, M Eljareh, Aej Al Gasi, S Alsaeiti, A S Alkhafeefi, T Suliaman, Aha Alanasri, Aba Haroun, A Haron, A I Kilani, M Ahmed, M Alawami, A Alawami, M Albashri, M Abusannuga, A Malek, N Jwaili, A Aldenfria, N Jwaili, F Elzwawi, A Almugaddami, Asa Egdeer, M Masoud, B Alazzabi, B Alezabi, A Shuwayyah, Aas Alkamkhe, I Aboulqasim, H Atiyah, Raa Alfagi, A Abdulmula, A Bouhuwaish, A Samer, R Salim, H Aboazamazem, B Almiqlash, M Biala, W Alganimi, R Ghamgh, N Ben Omar, A Alsoufi, M Aldreawi, N Saleim, F Sowan, H Saleem, Aqueelah Ahmed, N E Samalavicius, O Aliosin, S Dailidenas, A Dulskas, B Buckus, Z Kuliesius, R Bradunaite, I Dominguez-Rosado, G A Buerba, O E Posadas-Trujillo, A Alfaro-Goldaracena, R Cortes, M A Mercado, J L Beristain-Hernandez, V S Mora-Munoz, J M Mena-Bedolla, A R Palacios Ramirez, M M Astorga Medina, G Van Aert, S Ombashi, R Spillenaar Bilgen, D Vos, M Besselink, V Alberts, O Busch, W Bemelman, M Boermeester, F Daams, M Gordinou De Gouberville, P Van Duijvendijk, M De Graaff, J Baaij, S Gans, K Bos, B Goudsmit, B Den Dekker, A Braat, A Kuijpers, S Breukers, I Borel Rinkes, D Andel, T Hayes, D Carson, S Bhat, J van der Have, C Anderson, I Bissett, J Windsor, B M Elliott, H Scowcroft, J Mclauchlan, D Ritchie, F Jeffery, S Connor, W Xu, C Varghese, H Mashlan, V Thirayan, J Ly, M J Mcguinness, L Ferguson, I Watt, C Harmston, A Akinmade, A Adeyeye, E Enoch, V Kayode-Nissi, I Ogundele, B A Ayoade, A Adekoya, C Nwokoro, A Opadeyi, A Adeyeye, A Yusuf, A Ojajuni, O Adepoju, Maigatari Muhammad Dauda, Musa Keffi Mubarak, Khalid Lawal, Daniyan Muhammad, D Salonga, N A Sael, C M Rey, M Pestano, D Tan, N R Bangayan, D K Sy, D Ang, E Bernardo, J P Chua, M Alharthi, W Bukhari, K Bakier Mohammed, S Al Athath, M Ghunaim, H Saiedi, N Sultan, A Farsi, M Basendowah, M Alharthi, M Ghunaim, N Malibary, H Jaloun, Db Altalhi, A Organjee, M Moamena, T M Al Zaidi, M Alyami, M Alqannas, M Al-Urfan, A Elawad, A Alawadhi, Y Alalawi, A Alqarni, B Alqahtani, A Alayed, K Alsobaie, H Adi, N Malibary, M Elhaj, A Dehlawi, G Behairy, I Khaled, S Kmezic, D Radenkovic, L Aleksic, V Markovic, I Pejovic, A Antic, M Kalkan, O Vujanovic Gadjanski, S Dusan, B Marčetić, N Thiruchelvam, Akh Chiow, L S Lee, Dyc Mun, E K Tan, Y X Koh, W L Loh, Z Wang, C Y Chan, M Ibrahim, Hks Hamid, R Idres, M Idris, O Mohammed, S Ayran, A H Sinan, O Kouli, V Ozben, E Aytac, Z Aliyeva, A U Mutlu, I A Bilgin, T Karahasanoglu, I Hamzaoglu, B Bozkirli, T K Uprak, T Kotan, M Coskun, Y Kara, E Somuncu, A Kocatas, M A Bozkurt, S Demirli Atici, T Kaya, I Sert, M Emiroglu, M Jaffar, M U Younis, T Aziz, F Ikram, M Sandal, F Al Madhloum Al Suwaidi, M O Alshaikh, A Saber, A Khammas, A Nessa, R Jardine, L Nicol, C Clark, A Mcgee, B Alkari, M Feretis, R Antakia, F Georgiades, J Moneim, R O'Neill, A Balakrishnan, R Lunevicius, A Sud, I Moutsos, D Gomez, S Shahid, T Majeed, Wkg Ibrahim, K Kadum, R Melia, C Magee, D W Chicken, S Kumar, M Alshibshoubi, S van Laarhoven, F Dewi, J Williams, B Byrne, P Wilkerson, C B Tang, N Farhangmehr, A Jonas, V Charavanamuttu, K Almeida, E Efthimiou, J Boardley, A White, M A Butt, D Menzies, Z Gundkalli, D Hassanzadeh-Baboli, O Jones, P Mistry, S Saha, A Gerrard, J Evans, S Rajeev, W Ali, E Ross, A Gilliam, C Hitchins, K Emslie, K Spellar, H Sked, C Briggs, L Brown, N A Hemadasa, J R Apollos, A Belgaumkar, A Tawfik, L Brewin, B Oyewole, H Wadhawan, E Massie, D Rutherford, K Mcgivern, L Mcelroy, H D De'Ath, M Tobbal, S Nagendram, P Patel, S Handa, G Houghton, S S Sundaralingam, J Parker, R Morgan, T Gala, S Ibrahim, R Mithany, M Abdelkarim, D Holroyd, D Carson, R Thomas, E Mclennan, R Boardley, N B Jamieson, H Ebied, J Gossage, A Davies, S Wheatstone, Z Jawad, L Jiao, P Rajagopal, M Sodergren, M Lami, H Gacaferi, A Wiberg, G Bond-Smith, E Gemmill, E Lenzi, D Sapre, P Herrod, H Boyd-Carson, G Garcea, E Issa, A Jackson, T Fashina, H Pan, B Farquharson, H Shafiq, O Emanuel, S Mahdi, S Jeyarajah, L Finch, G Whiting, L Pigott, J Martin, A Siriwardena, K Beatson, L Abawi, W Lam, W Rea, B Andrews, B Al-Sarireh, F Soliman, J Burridge, C Jenvey, M Hammoda, M Hollyman, L Merker, J Richards, V Sukumaran, S Rogers, C Payne, S Bibi, K Raza, N Ul Ain, S Dronamraju, S Patil, S Nachimuthu, S Ravindran, S Patel, B Ivanov, M Patel, F Ejtehadi, J Jebamani, M M Akhter Rahman, H Woodun, A De Prendergast, A Afzal, E Bota, A Gupta, S R Abdul, R Karmarkar, E Crockett, L Evans, B Appleton, E Griffiths, O Dada, R Kulkarni, H Albirnawi, P Gravestock, C Vincenti, S Taribagil, B Dent, C Tse, B Clayton, E Burdekin, L Bannister, I Alam, J Gray, M Mactier, A Pollock, V Gough, S R Kanchustambam, M Ridgway, K Arujunan, S Gopalswamy, J Monteiro De Barros, T Lyons, D Griffith, A K Awan, J Latif, N Bandlamudi, I Bhatti, D A Raptis, N Machairas, T Pissanou, J Mestre-Costa, C Hidalgo Salinas, J M Pollok, M Al-Ardah, A White, E Watson-Jones, T Rontree-Carey, T Boyce, P Hawkin, A Elmaradny, K Ross, E Adu-Peprah, K Pinto, D Dunne, R Mccready, G Nita, P Szatmary, V L Tay, K Rajput, I Rajendran, M Chaudhury, G Zambas, C Swaminathan, Qaa Atif, T Barrow, O Williams, A Malik, S Conroy, S Lindley, K Gilmore, E Boden, S K Richards, I Hraishawi, P Polak, D Mclaughlin, D Deeny, R Shuttleworth, A Harris, A Peilober-Richardson, G C Morris, X Sara, H Almourad, Y Ang, R Smyth, D Ding, J Foster, A Bond, Y Kumar, A Ahmad, D Radoi, A Alkaili-Alyamani, S Balakrishnan, R Y Satchidanand, A S Danwaththa Liyanage, I Blake, M Ransome, C Weerasinghe, C Kenington, K Mayo, M Mohammed, A J Cockbain, A Peckham-Cooper, G Mccauley, C Gordon, A Smith, W Hawkins, S Chakravartty, C Baillie, R Kenny, A Kumar, G Koimtzis, E Bellamy, A Menon, A Kanakala, E J Nevins, A Madhavan, S Thulasiraman, K France, A O'Connor, D Idama, C Raslan, S Sridhar, M Parveen, T Mubashar, S Jarvis, I Cakmak, C Wright, S Andrews, Y Abdelsaid K Abdul Aal, B Jayasankar, J Morilla, M Shehata, N Subba, N Tewari, C El-Sayed, D Somaie, N Beheiry, E Douka, S Arumugam, I Wijetunga, E Leivers, B Ibrahim, K Khan, J Wheat, J Christopher, R Barnett, H Elberm, J Booker, S Ashai, D Berry, A Luhmann, A Sgro, M M Rashid, M Galea, J Jeyakumar, P Marriott, S Zafar, A Baker, D Yershov, G Galanopoulos, A Gupta, R Jordan, C Peinado Garcia, N Anyaugo, M F Bath, J Evans, J Omatseye, L Roberts, E O Argyriou, M Machesney, C Parmar, S Clark, H Khalil, S Unsworth, M Mlotshwa, N Ayoub, A Aboelkhair, E Iosif, N Mohamed, E Reynolds, E Mackender, D Robinson, W Mufti, K Fischkoff, N Coleman, S Anantha Sathyanarayana, G Deutsch, M Giangola, D Lin, M Weiss, C Chung, A Nguyen, J Mueller, M Dabit, J Gordon, E McGuire, O Rashid, E Georgi, M Gallo, J W Kunstman, N V Peters, R O'Connor, B Bhattacharya, E Onkendi, A P Santos, R Richmond, M Warren, K Zhang, R Broderick, B Clary, S Horgan, J Doucet, A Liepert, L Harmon, C McCall, J G Sham, E Williams, K P Labadie, N M Clark, L K Dickerson, C W Hammill, G Williams, B Kushner, H Cos, J Zarate Rodriguez, K Bailey, Imn Al-Raimi, K Al-Zazay, S Ahmed Mohammed Al-Mahdi, S Mohammed Aldowbli, M Al-Shehari, S Shream, S Al-Ameri, M Aeed, H Al-Naggar, M Aldawbali, R Alsayadi, M Alsayadi

Affiliations

¹ Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
² Cambridge Hepato-pancreato-biliary Unit, Addenbrooke's Hospital, Cambridge, UK.

Abstract

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality.

Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121).

Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic.

MeSH terms

COVID-19* / epidemiology
Cholecystectomy
Cholecystitis, Acute* / epidemiology
Cholecystitis, Acute* / surgery
Humans
Pandemics
SARS-CoV-2