Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic

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.

Outcomes of patients undergoing elective liver and pancreas cancer surgery during the SARS-CoV-2 pandemic: an international, multicentre, prospective cohort study

“…When resources are constrained, operating upon patients more likely to have a good outcome reduces the strain on precious critical care resources and risk stratification should be considered. It is also possible that the higher peak mortality rate was related to a failure to rescue patients following complications due to resource constraints caused by the pandemic, also seen in a Spanish study of emergency general and gastrointestinal surgery patients ( 30 ).…”

The impact of COVID-19 on surgical procedures in Japan: analysis of data from the National Clinical Database

“…Moreover, 15 (44%) of the 34 patients with confirmed infection required ICU management, with a postoperative mortality rate of 20.5% [ 37 ]. Osorio J, et al also reported that COVID-19 positive patients who underwent emergency general and gastrointestinal surgery during the pandemic had more complications and a higher likelihood of failure rescue than COVID-19 negative patients [ 38 ].…”

To answer quickly or rigorously? Scientific strategies for the new surgical questions after the emergence of COVID-19

“…First, to assess the impact of COVID-19 infection on postoperative mortality, COVID-19-positive patients were compared with COVID-19-negative patients operated on during the pandemic using propensity-score matching, matching patients with similar age, baseline pathologies and general condition at the time of surgery. Although the crude postoperative mortality of the two groups was very different (12.6% vs. 4.6%), this difference did not reach statistical significance after propensity-score matching (odds ratio 1.58, 95% CI .88-2.74) 3 . In other words, the high mortality observed in COVID-19 infected patients undergoing emergency surgery was due more to their age, underlying pathology and preoperative clinical status than to a hypothetical synergistic effect of the virus.…”

“…At the same time, to assess the effect of confinement, the surgical pathology status of the COVID-19-negative patients operated on during the pandemic was compared with those operated on the previous year. It was found that, during the pandemic, the patients did not present more advanced peritonitis or greater surgical complexity, and the inflammatory parameters of their analyses did not show higher values 3 . Thus, the higher mortality observed during the pandemic could not be attributed to patients consulting later due to confinement.…”

“…Finally, to assess the consequences of hospital collapse, intra-pandemic COVID-19-negative patients were compared with those operated on before the pandemic, matching patients in both groups from the same hospital and of similar age, underlying pathology and severity of surgical pathology. It was found that COVID-19-negative patients operated on during the pandemic had the same risk of postoperative complications as those in the pre-pandemic period, but a higher risk of dying as a result of their complications (failure-to-rescue), probably as an effect of the situation of hospital collapse in the context of the pandemic 3 .…”