Table 3. Global multi-center elective procedure performance reductions and outcome determinants.
| COLORECTAL CANCER | |||||||
|---|---|---|---|---|---|---|---|
| No. | Authors (Year of publication) | Study design | Country | No. of healthcare centers (n) (Additional details) | Study period | Case performance reduction (%) (Additional details) | Outcome determinants |
| 1. | Hunger et al (2022) | Case-control | Germany | 66 (Nationwide; n = 176,783 patients) |
Period 1: March 2019–February 2020 Period 2: March 2020–February 2021 |
9.0% (p = 0.002) | • Ministry of Health recommendation to suspend elective surgical services (March 2020) • Low local COVID-19 prevalence • No uniform national pandemic response • Seasonal effect: Study period spanned seasons when regional COVID-19 incidence was lower, allowing for immediate surgery rescheduling • Oncologic procedures prioritised • Data were from medium-sized centers only • Limitations of available data (incomplete) • Delayed care-seeking due to fear of contagion |
| 2. | de la Portilla de Juan et al (2021) | Cross-sectional survey | Spain | 67 (Nationwide) | February–April 2020 | 79.1% (Complete or partial cessation of surgery) 32.8% (Complete cessation, 22/67 centers) 46.3% (Partial cessation, 31/67 centers) |
• Eligibility for interim NACRT (patient-specific) • Non-uniform mitigation capacity across centers • Non-uniform COVID-19 prevalence nationwide • Institutional adaptation of clinical protocols • ‘Window of opportunity’ approach–Elective surgery performed whenever feasible relative to local COVID-19 upsurges • National “state of alarm” declaration |
| 3. | Purdy et al (2022) | Cross-sectional | USA | 559 (Data obtained from Vizient Database; n = 5,605 patients with CRC) | November 2019–June 2020 | 39.0% (p<0.001) (Procedure type: Colectomy) | • No availability of SARS-CoV-2 test kits during initial months of pandemic, unable to proceed with surgery among untested patients • Recommendation from local Surgeon General to limit elective surgery performance during COVID-19 (March 2020) • Delayed diagnosis: Screening and diagnostic testing (e.g., colonoscopy) suspended • Patient-specific factors: • Patients’ comorbidities precluded hospital admission during COVID-19 (high risk profile) • Delayed care-seeking due to fear of contagion |