Impact of COVID-19 on presentation, management, and outcomes of acute care surgery for gallbladder disease and acute appendicitis

Table 2 Gallbladder disease presentation, management, and operative findings

	Gallbladder disease
	March–June 2019		March–June 2020		P value
	152		161
Diagnosis, n (%)					0.01
Symptomatic cholelithiasis	99	65%	81	50%
Acute cholecystitis	53	35%	80	50%
Tokyo criteria, mean (STD)	1.17	0.437	1.39	0.562	0.02
Symptom duration prior to ED (d), mean (STD)	2.9	5.8	4.2	12.7	0.21
ED length of stay (h), median (IQR)	5	(3.5–7)	5	(4–7)	0.55
Disposition from ED					0.02
Discharged, n (%)	52	34%	41	25%
Discharged with urgent follow up, n (%)	17	11%	15	9%
Admitted, n (%)	76	50%	104	65%
Other, n (%)	7	5%	1	1%
Time from presentation to OR (h), median (IQR)	18	(11–28.2)	19	(13–27.5)	0.42
Pre-op ERCP required, n (%)	22	14%	18	11%	0.40
Antibiotics during admission, n (%)	61	80%	98	94%	0.10
Underwent surgical procedure, n (%)	61	40%	83	52%	0.06
Symptomatic cholelithiasis	16	16%	22	27%	0.098
Acute cholecystitis	45	87%	61	76%	0.12
Operations performed, n (%)					0.75
Laparoscopic cholecystectomy	55	90%	75	90%
Laparoscopic converted to open cholecystectomy	2	3%	1	1%
Percutaneous cholecystostomy	4	7%	7	8%
Post-op diagnosis, n (%)					0.23
Acute cholecystitis only	38	62%	43	52%
Acute cholecystitis with gallbladder mucocele (Hydrops)	1	2%	2	3%
Acute gangrenous cholecystitis	6	10%	14	17%
Acute hemorrhagic cholecystitis	1	2%	0	0%
Symptomatic cholelithiasis	6	10%	11	13%
Chronic cholecystitis	1	2%	8	10%
Other	7	12%	6	7%
Choledocholithiasis present, n (%)–Biliary colic subgroup	24	16%	28	17%	0.92
Drains left in place post op, n (%)	8	13%	15	18%	0.39
Patients with additional procedures, n (%)	8	13%	7	8%	0.40
Drain placement	1	6%	0	0%
PICC line	0	0%	1	7%
Lysis of adhesions	0	0%	2	13%
Intra-op cholangiogram	1	6%	1	7%

ED: Emergency departments; ERCP: Endoscopic retrograde cholangiopancreatography; OR: Odds ratios; PICC: Peripherally inserted central catheters.