The impact of surgical capacity shortages on disease-related morbidity in benign conditions: a comparative cohort study of gallstone and inguinal hernia care during the COVID-19 pandemic

BACKGROUND: With increasing pressure on operating room capacity due to growing surgical demand and constraints in cost, workforce, and sustainability, real-world scenarios such as the COVID-19 pandemic offer valuable insights. This study assessed the pandemic's impact on surgical care for patients with gallstone disease or inguinal hernia, focusing on disease-related and surgical complications. METHODS: This multicenter historical cohort study included patients treated in 2019 and 2020 at three Dutch hospitals. Data were collected from hospital systems and patient records. The COVID period (March-December 2020) was compared to a reference period (March-December 2019). The primary outcome of this study was the rate of disease-related complications. Secondary outcomes included surgery rates, hospital presentations and admissions, time to surgery, surgical complications, length of hospital stay, and readmissions. RESULTS: In total, 1572 patients with gallstone disease and 1511 with inguinal hernia were included. During the COVID period, fewer cholecystectomies were performed (59.8% vs. 67.7%, p = 0.001), and complicated gallstone disease increased (28.5% vs. 21.6%, p = 0.002). No significant differences were found in the rate of inguinal hernia repairs (61.6% vs. 63.5%, p = 0.46) or hernia-related complications (5.4% vs. 3.7%, p = 0.139). Surgical complication rates were similar across both periods for both conditions. CONCLUSIONS: Limited surgical availability during the COVID-19 period was linked to reduced cholecystectomy rates and more complicated gallstone disease, without affecting inguinal hernia outcomes or surgical complication rates.