Background: The reconstruction of anorectal surgery in the context of COVID-19 pandemic is ongoing. Objective: This study aims to examine the impact of COVID-19 pandemic on inpatient surgical treatment in patients with benign anorectal diseases. Design: This was a retrospective, single-center, observational study. Settings: The study was conducted in a hospital affiliated to a provincial medical university in China. Patients: This study included patients admitted from December of the last three years to March of the following year (total 1353). Main outcome measures: The patients' gender, age, first diagnosis, main symptoms and their worse days, pre-admission treatment, date of admission and discharge, length of hospital days, straight-line distance between residence and the hospital, and comorbidities were recorded. Results: Lockdown led to a decline in admissions, a reduction of hospital days (p<0.001), and changes in the proportion of different diseases admissions (p=0.032). The distance between residence and the hospital was reduced. Each wave of the outbreak was associated with prolonged hospital days. The hospital stay was not significantly affected in patients with colorectal polyps (p=0.564), but their number of hospital admissions greatly reduced. Limitations: This study was limited by the limited number of patients during the lockdown period and the lack of data about outpatient and unadmitted patients. Conclusions: The reconstructive process in colorectal surgery remains fraught with difficulties. The determinant of patient admission is the urgency and severity of the symptoms. Pre-admission treatment was not significantly affected. Care should be given to possible adverse outcomes due to reduced admissions for colorectal polyps. Lockdown causes shorter hospital stays over a short time, but the outbreaks still causes longer hospital stays over the relatively long term. To accelerate reconstruction, outpatient treatment should return to normal as soon as possible.

Yu Zhuang and Wenzhe Feng. The Impact of COVID-19 Pandemic on Inpatient Surgical Treatment in Patients with Benign Anorectal Diseases. International Journal of Health and Pharmaceutical Medicine (2023), Vol. 4, Issue 1: 144-155. https://doi.org/10.38007/IJHPM.2023.040115.

[1] Nicola, M., Alsafi, Z., Sohrabi, C., Kerwan, A., Al-Jabir, A., Iosifidis, C., Agha, M. and Agha, R. (2020) The socio-economic implications of the coronavirus pandemic (COVID-19): A review. International journal of surgery (London, England), 78, 185-193. https://doi.org/10.1016/j.ijsu.2020.04.018

[2] Benke, C., Autenrieth, L. K., Asselmann, E. and Pané-Farré, C. A. (2020) Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry research, 293, 113462. https://doi.org/10.1016/j.psychres.2020.113462

[3] Cicuttini, F.M., Tran, T.D., Hussain, S.M., et al.; Monash COVID Restrictions Research Group. (2020) Determinants of worse care for non-COVID-19 health or disability needs in Australia in the first month of COVID-19 restrictions: A national survey. Health Soc Care Community, 30(5):e2559-e2570. https://doi.org/10.1111/hsc.13699

[4] Kruse, M.H., Durstine, A. and Evans, D.P. (2022) Effect of COVID-19 on patient access to health services for noncommunicable diseases in Latin America: a perspective from patient advocacy organizations. International journal for equity in health, 21(1), 45. https://doi.org/10.1186/s12939-022-01648-x

[5] Li, H., Ling, F., Zhang, S., Liu, Y., Wang, C., Lin, H., Sun, J. and Wu, Y. (2022) Comparison of 19 major infectious diseases during COVID-19 epidemic and previous years in Zhejiang, implications for prevention measures. BMC infectious diseases, 22(1), 296. https://doi.org/10.1186/s12879-022-07301-w

[6] Ma, C., Guo, X., Wang, L., Li, W., Liu, S., Lin, F. and Xu, W. (2022) The impact of the COVID-19 pandemic on the incidence and mortality of zoonotic diseases in China. BMJ global health, 7(1), e007109. https://doi.org/10.1136/bmjgh-2021-007109

[7] Blecker, S., Jones, S.A., Petrilli, C.M., Admon, A.J., Weerahandi, H., Francois, F. and Horwitz, L.I. (2021) Hospitalizations for Chronic Disease and Acute Conditions in the Time of COVID-19. JAMA internal medicine, 181(2), 269-271. https://doi.org/10.1001/jamainternmed.2020.3978

[8] Guimarães, R.A., Policena, G.M., Paula, H.D.S.C., Pedroso, C.F., Pinheiro, R.S., Itria, A., Braga Neto, O.O., Teixeira, A.M., Silva, I A., Oliveira, G.A. and Batista, K.A. (2022) Analysis of the impact of coronavirus disease 19 on hospitalization rates for chronic non-communicable diseases in Brazil. PloS one, 17(3), e0265458. https://doi.org/10.1371/journal.pone.0265458

[9] Pellino, G., Vaizey, C.J., Maeda, Y. and European Society of Coloproctology (ESCP) Guideline Committee (2020) The COVID-19 pandemic: considerations for resuming normal colorectal services. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland, 22(9), 1006-1014. https://doi.org/10.1111/codi.15313

[10] Gallo, G., Grossi, U., Sturiale, A., Di Tanna, G.L., Picciariello, A., Pillon, S., Mascagni, D., Altomare, D.F., Naldini, G., Perinotti, R. and Telemedicine in Proctology Italian Working Group (2021) E-consensus on telemedicine in proctology: A RAND/UCLA-modified study. Surgery, 170(2), 405-411. https://doi.org/10.1016/j.surg.2021.01.049

[11] Wu, X.R., Zhang, Y.F., Lan, N., Zhang, Z.T., Wang, X.S., Shen, B., Lan, P., Kiran, R.P., and Chinese Society of Colorectal Surgery of China Medical Association (2020) Practice Patterns of Colorectal Surgery During the COVID-19 Pandemic. Diseases of the colon and rectum, 63(12), 1572-1574. https://doi.org/10.1097/DCR.0000000000001840

[12] Feng, Y. and Zhou, L. (2021) Risk analysis of poor wound healing in forceps delivery. The journal of obstetrics and gynaecology research, 47(10), 3509-3515. https://doi.org/10.1111/jog.14906

[13] Patel, P.P., Weller, J.H., Westermann, C.R., Cappiello, C., Garcia, A.V. and Rhee, D.S. (2021) Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-Pediatric Study. The Journal of surgical research, 267, 556-562. https://doi.org/10.1016/j.jss.2021.06.029

[14] Parola, M. and Pinzani, M. (2019) Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues. Molecular aspects of medicine, 65, 37-55. https://doi.org/10.1016/j.mam.2018.09.002

[15] Okonkwo, U.A. and DiPietro, L.A. (2017) Diabetes and Wound Angiogenesis. International journal of molecular sciences, 18(7), 1419. https://doi.org/10.3390/ijms18071419

[16] Davis, B.R., Lee-Kong, S.A., Migaly, J., Feingold, D.L. and Steele, S.R. (2018) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Diseases of the colon and rectum, 61(3), 284-292. https://doi.org/10.1097/DCR.0000000000001030

[17] Gaertner, W.B., Burgess, P.L., Davids, J.S., Lightner, A.L., Shogan, B.D., Sun, M.Y., Steele, S.R., Paquette, I.M., Feingold, D.L. and Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons (2022) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Diseases of the colon and rectum, 65(8), 964-985. https://doi.org/10.1097/DCR.0000000000002473

[18] Lee, J.K., Lam, A.Y., Jensen, C.D., Marks, A.R., Badalov, J., Layefsky, E., Kao, K., Ho, N.J., Schottinger, J.E., Ghai, N.R., Carlson, C.M., Halm, E.A., Green, B., Li, D., Corley, D.A. and Levin, T.R. (2022) Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population. Gastroenterology, 163(3), 723-731.e6. https://doi.org/10.1053/j.gastro.2022.05.014

[19] Maringe, C., Spicer, J., Morris, M., Purushotham, A., Nolte, E., Sullivan, R., Rachet, B. and Aggarwal, A. (2020) The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. The Lancet. Oncology, 21(8), 1023-1034. https://doi.org/10.1016/S1470-2045(20)30388-0

[20] Tao, R., Qu, Z., Sun, D.F., Deng, Y.M., Mo, Y., Chen, J., Zhang, Y., Xie, X., Tang, W.S. and Liu, W.D. (2019) Interpretation of clinical practice guideline for anorectal day surgery 2019 edition. Chinese journal of gastrointestinal surgery, 22(12), 1118-1123.

[21] Tyler, K.M., Baucom, R.B., Patel, J.A., Sentovich, S.M. and Healthcare Economics Committee of the American Society of Colon and Rectal Surgeons (2021) Update: Telehealth in Colon and Rectal Surgery. Diseases of the colon and rectum, 64(6), 642-644. https://doi.org/10.1097/DCR.0000000000002019

[22] Zhou, Y., Chen, S., Liao, Y., Wu, Q., Ma, Y., Wang, D., Wang, X., Li, M., Wang, Y., Wang, Y., Liu, Y., Liu, T. and Yang, W.F.Z. (2021) General Perception of Doctor-Patient Relationship from Patients During the COVID-19 Pandemic in China: A Cross-Sectional Study. Frontiers in public health, 9, 646486. https://doi.org/10.3389/fpubh.2021.646486