key: cord-0969404-udcczp5e
authors: Holmberg, Marcus; Koppatz, Hanna; Jansson, Anders; Hillingsø, Jens Georg; Noergaard Larsen, Peter; Lassen, Kristoffer; Sallinen, Ville; Yaqub, Sheraz; Sparrelid, Ernesto
title: Secondary effects of the COVID-19 pandemic on surgical management of hepatopancreatobiliary malignancies in the Nordic capitals
date: 2021-12-01
journal: Br J Surg
DOI: 10.1093/bjs/znab405
sha: a37dcae121fa375ce739bfd79206736ae616267c
doc_id: 969404
cord_uid: udcczp5e

nan

The impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the healthcare sector has been immense, including cancellation of elective hepatopancreatobiliary (HPB) surgery for malignancy in some regions [1] [2] [3] [4] . Countries have chosen different strategies to tackle COVID-19, from authoritarian measures to looser, citizen-focused strategies (individual responsibility). The Nordic countries displayed this spectrum-from Finland's strict to Sweden's looser approach, and Denmark and Norway somewhere in between. Irrespective of prevailing strategy, a reluctancy to seek medical attention during the pandemic may have delayed surgical resection. There are limited data on the effects of COVID-19 on HPB malignancy, so this retrospective study assessed surgical numbers for 2018-2020 in the Nordic capitals (Copenhagen, Oslo, Stockholm, and Helsinki). Prepandemic and intrapandemic quarterly resection numbers are presented by region/capital and by time period. The commencement of the Nordic COVID-19 pandemic was arbitrarily set to the beginning of the second quarter of 2020. COVID-19-related ongoing ICU cases on a weekly basis were chosen as a marker of regional COVID-19 load. Statistical analyses were performed using the Mann-Whitney U test, with P < 0.050 considered significant.

The results are presented in Fig. 1 , including 5565 HPB resections (2018-2020); there were 480 resections before and 447 resections quarterly per centre during the pandemic (À7.3 per cent; P ¼ 0.347). A decline in resection numbers was present in all regions: Helsinki (À1.2 per cent), Stockholm (À3.4 per cent), Copenhagen (À4.7 per cent), and Oslo (À21.2 per cent; P ¼ 0.016). All participating centres bear testimony to organizational flexibil-ity, as recommended in BJS 4 , to maintain HPB surgery for malignancy 1 .

Possible explanations for the fact that Oslo was affected most by the pandemic could be the reluctance of patients to seek medical attention, surgical decision-making, or hospital system plasticity issues. Disclosure. The authors declare no conflict of interest.

Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services

Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area

Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans

BJS Commission Team. BJS commission on surgery and perioperative care post-COVID-19