ABSTRACT
Introduction: Shortly after the onset of the COVID-19 pandemic, SARS-CoV-2 virus was discovered in non-respiratory bodily fluids. This raised the potential of aerosolizing virus with insufflation. The aim of this study was to compare trends in surgical approach and indication at the start of the pandemic. Method(s): A retrospective cohort study was performed using the National Surgical Quality Improvement (NSQIP) Participant Use File and Targeted Colectomy databases to identify patients undergoing colon resections in 2020. Cohorts were divided by quarter of operation (Q1-Q4). The minimally invasive cohort included all cases using an insufflation-based approach. Primary outcomes included planned open operation. Multivariate analysis was used to assess confounders and effect modification on open operation. Result(s): Univariate analysis found the percentage of open colonic resections was greater in Q2 of 2020 with a subsequent return to pre-pandemic levels (38% Q2 vs 32%, 34%, and 33% for Q1, Q3, Q4 respectively;p< 0.001). There was a concordant increase in emergent surgeries (20% in Q2 vs 15% Q1), but multivariate analysis revealed having operation in Q2 independently increased the odds of having open operation (OR 1.11, p=0.004). Serious complication rate was highest in Q2 (17% vs 14%, 16%, 16% for Q1, Q3, Q4;p <0.001). Conclusion(s): There was an increase in the percentage of open colon resections in Q2 of 2020. Multivariate analysis found having operation in Q2 independently increased the odds of an open operation. The increase in planned open operation was potentially related to concern for SARS-CoV-2 becoming aerosolized in minimally invasive cases.