Outcomes of hepato-pancreato-biliary surgery during the COVID-19 pandemic: an International Hepato-Pancreato-Biliary Association (IHPBA) cross-sectional survey

Background In response to the pandemic, the International Hepato-Pancreato-Biliary Association (IHPBA) aspired to conduct a survey to assess the impact of COVID-19 on HPB surgery outcomes. This led to the development of the IHPBA-COVID Registry in order to capture global data on HPB surgery outcomes of COVID positive patients. The registry aimed to provide a tool to help members gain a better understanding of the consequences of COVID-19 on patients’ outcomes after HPB surgery worldwide. Methods An online survey updated in real time was disseminated to all IHPBA, E-AHPBA, A-HPBA and A-PHPBA members to assess the effects of the pandemic on the outcomes of HPB procedures, perioperative COVID-19 management and other aspects of surgical care. Results One hundred twenty-five patients from 35 centres in 18 countries were included. Seventy-three (58%) patients were diagnosed with COVID-19 preoperatively. Operative mortality after pancreaticoduodenectomy and major hepatectomy was 28% and 15%, respectively, and 2.5% after cholecystectomy. Postoperative complication rates of pancreatic procedures, hepatic interventions and biliary interventions were respectively 80%, 50% and 37%. Respiratory complication rates were 37%, 31% and 10%, respectively. Conclusion This study reveals a high risk of mortality and complication after HPB surgeries in patient infected with COVID-19. The more extensive is the procedure, the higher is the risk. Nonetheless, an increased risk was observed across all types of interventions, suggesting that elective HPB surgery should be avoided in COVID positive patients, delaying it at distance from the viral infection.