Impact of the COVID-19 pandemic on gastric surgery in Japan: A nationwide study using interrupted time-series analyses

Misuzu Fujita; Kazuya Yamaguchi; Kengo Nagashima; Kiminori Suzuki; Tokuzo Kasai; Hideyuki Hashimoto; Yoshihiro Onouchi; Daisuke Sato; Takehiko Fujisawa; Akira Hata

doi:10.1111/jgh.16533

Impact of the COVID-19 pandemic on gastric surgery in Japan: A nationwide study using interrupted time-series analyses

J Gastroenterol Hepatol. 2024 Mar 7. doi: 10.1111/jgh.16533. Online ahead of print.

Authors

Affiliations

¹ Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan.
² Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan.
³ Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.
⁴ Hospital and Health Administration, Fujita Health University Graduate School of Medicine, Toyoake, Japan.

PMID: 38454806
DOI: 10.1111/jgh.16533

Abstract

Background and aim: Changes in the number of surgeries for gastric cancer during the coronavirus disease 2019 (COVID-19) pandemic have been reported, but data are insufficient to understand the impact at the national level. This study aimed to determine the impact of the COVID-19 pandemic on gastric surgery in Japan.

Methods: Insurance claims data registered from January 2015 to January 2021 were used. Changes in the number of endoscopic resections and gastrectomies for gastric cancer were estimated using an interrupted time-series analysis.

Results: The number of endoscopic resections significantly decreased in July 2020 (-1565; 95% confidence interval [CI]: -2022, -1108) and January 2021 (-539; 95% CI: -970, -109), and the number of laparoscopic surgeries significantly decreased in July 2020 (-795; 95% CI: -1097, -492), October 2020 (-313; 95% CI: -606, -19), and January 2021 (-507; 95% CI: -935, -78). Meanwhile, the number of open gastrectomies remained unchanged, and the number of robot-assisted gastrectomies steadily increased since their coverage by public health insurance in April 2018.

Conclusions: The decreased number of endoscopic resections and laparoscopic surgeries in Japan suggests a decline in early-stage gastric cancer diagnosis, likely due to the suspension of gastric cancer screening and diagnostic testing during the pandemic. Meanwhile, the number of open and robot-assisted gastrectomies remained unchanged and increased, respectively, indicating that these applications were not affected by the pandemic-related medical crisis. These findings highlight that procedures for cancer diagnosis, including screening, should still be provided during pandemics.

Keywords: COVID-19 pandemic; gastric cancer; insurance claims analyses; surgery.