Emergency abdominal surgery in COVID-19 patients: a note of caution from Wuhan

Fu, Dehao; Zhang, Pei; Wang, L; Liu, W; Tan, Huayong; Di, Maojun; Cai, Meng; Zhang, Peng; Tao, Kaixiong; Wang, G; Jiang, Cheng; Wang, Z

doi:10.1002/bjs.11722

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…Our results are in concordance with those reported in other studies [5–15], indicating that patients with COVID‐19 infection undergoing surgery are at higher risk of mortality, mainly due to respiratory complications. In this study, 30‐day mortality was 12.8% in patients with COVID‐19 infection, which is a rate lower mortality than the report of other reviews [5, 6, 8, 9, 13].…”

Section: Discussionsupporting

confidence: 93%

“…In the most significant study published to date by the CovidSurg group, the overall 30-day mortality was 23.8%, with 51.2% of respiratory complications and a mortality rate from respiratory complications of 38% [5]. Other studies report general mortality rates ranging from 12.5 to 83.3%, with respiratory morbidity even up to 100% [6][7][8][9][10][11][12][13][14][15]. An Italian series of 41 patients infected with COVID-19 who underwent surgery describe overall mortality of 19.5% and respiratory morbidity of 59% [8].…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory complications occurred in 51.2% of the patients, with a mortality of 38%, which represents 82.6% of all deaths in the study [5]. Other series have also shown high mortality rates between 20 and 25%, with respiratory complications been reported in up to 40-50% of patients [6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 98%

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Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

et al. 2021

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Background Severe acute respiratory syndrome due to coronavirus 2 has rapidly spread worldwide in an unprecedented pandemic. Patients with an ongoing COVID-19 infection requiring surgery have higher risk of mortality and complications. This study describes the mortality and morbidity in patients with perioperative COVID-19 infection undergoing elective and emergency surgeries. Methods Prospective cohort of consecutive patients who required a general, gastroesophageal, hepatobiliary, colorectal, or emergency surgery during COVID-19 pandemic at an academic teaching hospital. The primary outcome was 30-day mortality and major complications. Secondary outcomes were specific respiratory mortality and complications. Results A total of 701 patients underwent surgery, 39 (5.6%) with a perioperative COVID-19 infection. 30-day mortality was 12.8% and 1.4% in patients with and without COVID-19 infection, respectively (p \ 0.001). Major surgical complications occurred in 25.6% and 6.8% in patients with and without COVID-19 infection, respectively (p \ 0.001). Respiratory complications occurred in 30.8% and 1.4% in patients with and without COVID-19 infection, respectively (p \ 0.001). Mortality due to a respiratory complication was 100% and 11.1% in patients with and without COVID-19 infection, respectively (p \ 0.006). Conclusions 30-day mortality and surgical complications are higher in patients with perioperative COVID-19 infection. Indications for elective surgery need to be reserved for non-deferrable procedures in order to avoid unnecessary risks of non-urgent procedures.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

et al. 2021

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“…Some publications suggest that surgical procedures accelerate and exacerbate the clinical progression of COVID-19. [ 17 , 24 ] Several teams have recently described classic emergency surgical pathologies with “atypical” forms of presentation and/or complicated postoperative evolution, differing from the usual “pre-pandemic” scenario. [ 10 , 13 , 25 – 28 ]…”

Section: Introductionmentioning

confidence: 99%

Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic

Madrazo¹,

Osorio²,

Otero

et al. 2021

Medicine

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Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients. A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the “pandemic” cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the “control” cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients. The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings. ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).

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“…Second, clinical management of abdominal emergent surgery is different from usual practice. Due to emergency, COVID-19 infection in some patients might not be evidently excluded before surgery, which could potentially increase infection risk for surgical staff during operations and might increase mortality rate associated with COVID-19 infection during perioperative periods if patients were indeed COVID-19 infected 2 …”

Section: Challenges Facing General Surgeonsmentioning

confidence: 99%

Comment on “COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period”: Challenges and strategies for General Surgery Departments During Post-COVID-19 Era in Wuhan: Experiences and Recommendations From the Frontline

Wang

et al. 2020

Annals of Surgery

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Emergency abdominal surgery in COVID-19 patients: a note of caution from Wuhan

Cited by 6 publications

References 10 publications

Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic

Comment on “COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period”: Challenges and strategies for General Surgery Departments During Post-COVID-19 Era in Wuhan: Experiences and Recommendations From the Frontline

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