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A population-based analysis of the COVID-19 generated surgical backlog and associated emergency department presentations for inguinal hernias and gallstone disease

Gomez D, Nantais J, Telesnicki T, de Mestral C, Wilton AS, Stukel TA, Urbach DR, Baxter NN. Ann Surg. 2022; 275(5):836-41. Epub 2022 Jan 25. DOI:

Objective — To evaluate the downstream effects of the COVID-19 generated surgical backlog.

Background — Delayed elective surgeries may result in emergency department (ED) presentations and the need for urgent interventions.

Methods — Population-based repeated cross-sectional study utilizing administrative data. We quantified rates of elective cholecystectomy and inguinal hernia repair and rates of ED presentations, urgent interventions, and outcomes during the first and second waves of COVID-19 (March 1, 2020-February 28, 2021) as compared to a 3-year pre-COVID-19 period (January 1, 2017-February 29, 2020) in Ontario, Canada. Poisson generalized estimating equation models were used to predict expected rates during COVID-19 based on the pre-COVID-19 period. The ratio of observed (actual events) to expected rates was generated for surgical procedures (SRRs) and ED visits (ED-RRs).

Results — We identified 74,709 elective cholecystectomies and 60,038 elective inguinal hernia repairs. During the COVID-19 period, elective inguinal hernia repairs decreased by 21% (SRR 0.791; 0.760-0.824) whereas elective cholecystectomies decreased by 23% (SRR 0.773; 0.732-0.816). ED visits for inguinal hernia decreased by 17% (ED-RR 0.829; 0.786-0.874) whereas ED visits for gallstones decreased by 8% (ED-RR 0.922; 0.878-0.967). A higher population rate of urgent cholecystectomy was observed, particularly after the first wave (SRR 1.076; 1.000-1.158). No difference was seen in inguinal hernias.

Conclusions — An over 20% reduction in elective surgeries and an increase in urgent cholecystectomies was observed during the COVID-19 period suggesting a rebound effect secondary to the surgical backlog. The COVID-19 generated surgical backlog will have a heterogeneous downstream effect with significant implications for surgical recovery planning.