J Osorio1, Z Madrazo1, S Videla2, B Sainz3, A Rodríguez-González4, A Campos5, M Santamaría6, A Pelegrina7, C González-Serrano8, A Aldeano9, A Sarriugarte10, C J Gómez-Díaz11, D Ruiz-Luna12, A García-Ruiz-de-Gordejuela13, C Gómez-Gavara14, M Gil-Barrionuevo15, M Vila16, A Clavell17, B Campillo18, L Millán19, C Olona20, S Sánchez-Cordero21, R Medrano22, C A López-Arévalo23, N Pérez-Romero24, E Artigau25, M Calle26, V Echenagusia27, A Otero2, C Tebe28, N Pallares28, S Biondo1. 1. Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain. 2. Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. 3. Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain. 4. Department of Surgery, Donostia University Hospital, San Sebastian, Spain. 5. Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain. 6. Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain. 7. Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain. 8. Department of Surgery, Basurto University Hospital, Bilbao, Spain. 9. Department of Surgery, Granollers General Hospital, Granollers, Spain. 10. Department of Surgery, Cruces University Hospital, Bilbao, Spain. 11. Department of Surgery, Althaia Foundation, Manresa, Spain. 12. Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain. 13. General Surgery Department, Vall d'Hebrón University Hospital, Barcelona, Spain. 14. Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain. 15. Department of Surgery, Viladecans Hospital, Viladecans, Spain. 16. Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain. 17. Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain. 18. Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain. 19. Department of Surgery, Dr José Molina Orosa Hospital, Lanzarote, Spain. 20. Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain. 21. Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain. 22. Department of Surgery, Sant Pau University Hospital, Barcelona, Spain. 23. Department of Surgery, Moisès Broggi Hospital, Sant Joan Despí, Spain. 24. Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain. 25. Department of Surgery, Girona Dr Josep Trueta University Hospital, Girona, Spain. 26. Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain. 27. Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain. 28. Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Abstract
BACKGROUND: Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. METHODS: Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. RESULTS: Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. CONCLUSION: Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.
BACKGROUND: Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. METHODS: Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. RESULTS: Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. CONCLUSION: Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.
Authors: Antonietta Lamazza; Maria Vittoria Carati; Anna Maria Pronio; Enrico Fiori; Angelo Antoniozzi; Antonio V Sterpetti Journal: Surgery Date: 2022-07-14 Impact factor: 4.348