Impact of COVID-19 lockdown on postoperative morbidity after hepatectomy: a propensity-score matching study on a national French database

BACKGROUND: SARS-CoV-2 pandemic impact on management of liver malignancies worldwide is unknown. This study aimed to determine the impact of lockdown on patient clinical pathways and postoperative morbi-mortality. METHODS: This study evaluated all adults’ hospital stays for liver tumour between 2019 and 2021 from national French discharge database. Primary outcome was clinical pathway, especially surgical care and postoperative outcomes, between patients admitted during COVID-19 lockdown periods (Lockdown group) and during the same periods of 2019 and 2021 (Control groups). RESULTS: Overall population included 58508 patients: 18907 patients in the Lockdown group, 20045 in the 2019 Control group and 19556 in the 2021 Control group. Surgical activity decreased by 11.6% during Lockdowns, with 1514 (8.0%) of patients in Lockdown group treated by surgery, 1514 (8.6%) in 2019 Control group (p<0.001) and 1466 (7.4%) in 2021 Control group. Chemotherapy was more considered during the lockdown (p<0.001). More patients were operated in small-volume centers during the lockdown (34%vs.32%vs.32%, p=0.034) and less were hospitalized in highly populated regions (p<0.001). Postoperative morbidity (47%vs.47%vs.47%, p=0.90) and mortality (3.3% vs. 3.6% vs. 3.1%, p=0.80) were comparable in the three periods, with no influence of lockdowns on morbidity (RR=0.94, CI95%=0.81-1.09, p=0.40) or mortality (OR=1.12, CI95%=0.72-1.74, p=0.6). Postoperative pulmonary (17%vs.13%, p=0.024) and septic complications (20%vs.15%, p=0.022) were significantly higher during the first lockdown compared to the second. CONCLUSION: This study provides a French overview of liver malignancies management during the COVID-19 pandemic. Surgical activity has decrease by 11.6%, moreover in the high-volume centers, with no impact on postoperative morbidity and mortality.