# Cholecystectomies in the shadow of COVID-19 pandemic: a retrospective analysis of 1075 patients – shift in patient behavior, hospital logistics, and perspectives for the future

## TL;DR

The study shows how the COVID-19 pandemic affected cholecystectomy patients and hospital practices, leading to delayed treatments and changes in surgical approaches.

## Contribution

The study provides new insights into how a global pandemic alters patient behavior and hospital logistics in surgical care.

## Key findings

- Patients delayed hospital visits during the pandemic, leading to more advanced disease at presentation.
- There was a significant increase in open cholecystectomies and a decline in laparoscopic procedures during the pandemic.
- Despite increased case complexity, hospital logistics and critical outcomes remained stable.

## Abstract

Our study aimed to depict the influence of the COVID-19 pandemic on patients diagnosed with acute or chronic cholecystitis undergoing cholecystectomy.

A retrospective cohort analysis was performed. The “Pre-pandemic cohort” (January 1, 2018, to March 21, 2020) was compared with the “Pandemic cohort” (March 22, 2020, to December 31, 2021), with March 22 marking the first national lockdown in Germany. A total of 1,075 patients were included (512 pre-pandemic, 563 during the pandemic). Demographic, clinical, perioperative, and postoperative variables were assessed. Descriptive and inferential statistical tests, including the Shapiro-Wilk and Mann-Whitney U tests, were applied.

Demographic profiles remained comparable between groups. Time from symptom onset to hospital presentation rose markedly (1.83 ± 4.75 vs. 8.49 ± 30.63 days, p < 0.001), while hospital workflow efficiency remained unaffected. Emergency procedures (25.4% vs. 31.1%, p = 0.02) and cases of acute cholecystitis (29.1% vs. 42.1%, p = 0.048) increased during the pandemic. Laparoscopic cholecystectomy remained the standard approach, though its relative frequency declined somewhat during the pandemic (89.9% vs. 81.9%), while open procedures tripled (4.2% vs. 13.5%, p < 0.01). Postoperative complication rates rose modestly (11.9% vs. 16.0%, p = 0.055), but did not reach statistical significance.

The COVID-19 pandemic significantly altered patient behavior and clinical presentation, leading to more advanced disease and changes in surgical strategy. Despite increased case complexity, hospital logistics and critical outcomes remained robust, underscoring the adaptability of surgical teams to overcome the challenges posed by systemic healthcare crises. Remarkably, our study demonstrates that even in the shadow of a global pandemic, surgical practice does not stand still—strategies shift, workflows adapt, and outcomes endure, offering reassurance that future disruptions can be approached with confidence rather than concern.

The online version contains supplementary material available at 10.1186/s12893-025-03445-z.