Increasing stoma requirements during the COVID-19 pandemic
EAES Academy. Kumaran N. 07/05/22; 363023; P067
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Abstract
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Aims:
The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Surveillance was paused, referral pathways decelerated and waiting times for cancer operations were prolonged. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously only had an anastomosis. This study aimed to identify whether changes made during the pandemic have resulted in an increase in patients requiring a stoma and its potential impact.
Methods:
All patients diagnosed with colorectal cancer and entered in the authors’ tertiary surgical unit cancer database in three 4-month intervals were included. These corresponded to
before the pandemic (March–June 2019), during the UK’s first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The total number of patients diagnosed with colorectal cancer and for those undergoing elective and emergency primary surgical resection, the incidence of stomas was compared between groups.
Results:
The total number of patients diagnosed showed a fall from the pre-pandemic number of 147 to 132 in the first wave. This recovered to 152 by the second wave. There was an increase in the interval between referral and surgery during the first wave compared with before the pandemic (average 118 and 78 days respectively; P=0.003).This was also evident during the second wave. (P=0.047). For patients undergoing elective surgery the incidence of stomas was 13% before the pandemic. However, this tripled to 39% during the first wave and further increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves.
Conclusion:
A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Surveillance was paused, referral pathways decelerated and waiting times for cancer operations were prolonged. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously only had an anastomosis. This study aimed to identify whether changes made during the pandemic have resulted in an increase in patients requiring a stoma and its potential impact.
Methods:
All patients diagnosed with colorectal cancer and entered in the authors’ tertiary surgical unit cancer database in three 4-month intervals were included. These corresponded to
before the pandemic (March–June 2019), during the UK’s first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The total number of patients diagnosed with colorectal cancer and for those undergoing elective and emergency primary surgical resection, the incidence of stomas was compared between groups.
Results:
The total number of patients diagnosed showed a fall from the pre-pandemic number of 147 to 132 in the first wave. This recovered to 152 by the second wave. There was an increase in the interval between referral and surgery during the first wave compared with before the pandemic (average 118 and 78 days respectively; P=0.003).This was also evident during the second wave. (P=0.047). For patients undergoing elective surgery the incidence of stomas was 13% before the pandemic. However, this tripled to 39% during the first wave and further increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves.
Conclusion:
A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
Aims:
The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Surveillance was paused, referral pathways decelerated and waiting times for cancer operations were prolonged. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously only had an anastomosis. This study aimed to identify whether changes made during the pandemic have resulted in an increase in patients requiring a stoma and its potential impact.
Methods:
All patients diagnosed with colorectal cancer and entered in the authors’ tertiary surgical unit cancer database in three 4-month intervals were included. These corresponded to
before the pandemic (March–June 2019), during the UK’s first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The total number of patients diagnosed with colorectal cancer and for those undergoing elective and emergency primary surgical resection, the incidence of stomas was compared between groups.
Results:
The total number of patients diagnosed showed a fall from the pre-pandemic number of 147 to 132 in the first wave. This recovered to 152 by the second wave. There was an increase in the interval between referral and surgery during the first wave compared with before the pandemic (average 118 and 78 days respectively; P=0.003).This was also evident during the second wave. (P=0.047). For patients undergoing elective surgery the incidence of stomas was 13% before the pandemic. However, this tripled to 39% during the first wave and further increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves.
Conclusion:
A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Surveillance was paused, referral pathways decelerated and waiting times for cancer operations were prolonged. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously only had an anastomosis. This study aimed to identify whether changes made during the pandemic have resulted in an increase in patients requiring a stoma and its potential impact.
Methods:
All patients diagnosed with colorectal cancer and entered in the authors’ tertiary surgical unit cancer database in three 4-month intervals were included. These corresponded to
before the pandemic (March–June 2019), during the UK’s first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The total number of patients diagnosed with colorectal cancer and for those undergoing elective and emergency primary surgical resection, the incidence of stomas was compared between groups.
Results:
The total number of patients diagnosed showed a fall from the pre-pandemic number of 147 to 132 in the first wave. This recovered to 152 by the second wave. There was an increase in the interval between referral and surgery during the first wave compared with before the pandemic (average 118 and 78 days respectively; P=0.003).This was also evident during the second wave. (P=0.047). For patients undergoing elective surgery the incidence of stomas was 13% before the pandemic. However, this tripled to 39% during the first wave and further increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves.
Conclusion:
A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
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