Evaluation of the difficulty of laparoscopic cholecystectomy during COVID-19 pandemic using externally validated prediction models: A retrospective cohort study

Introduction: During the COVID-19 pandemic, elective surgeries suspension, led to delayed hospital visits for non-emergent diseases like acute cholecystitis. Although nonsurgical treatment was successful in numerous cases, there are some warnings about the progression of the disease to more advanced stages for laparoscopy. In this study, we aimed to find out if COVID-19 had adverse effects on the difficulty of laparoscopic cholecystectomy (LC).Methods: In a retrospective cohort study at a referral center for minimally-invasive surgeries, medical records from February 2019 to February 2020 (before the pandemic) and from February 2020 until 2021 (during the outbreak) were reviewed and various data were extracted. Using two different preoperative scoring systems, we estimated the rate of difficulty of LCs, and the results compared to each other with appropriate statistical methods.Results: A total of 531 LCs were performed. Pre-COVID and post-COVID patients had a mean age of 46 +/- 15 and 44 +/- 14 years old, respectively, and less than 35 % of patients in each group were males. LCs decreased notably during the pandemic (161 vs. 369, p < 0.001). Besides, elective surgeries were reduced in this period (36.6 % vs. 55.7 %, p < 0.001). Despite no significant changes in operation duration (123 +/- 42 vs. 129 +/- 40, p = 0.16), scoring models revealed a remarkable change in difficulties.Conclusion: Using two well-established scoring models, we concluded that LCs were done with less difficulty during that period. However, there was a remarkable decrease in elective surgeries, and higher volume studies are required to confirm our results.