Mortality and pulmonary complications in emergency general surgery patients with COVID-19: A large international multicenter study

Abstract

The outcomes of emergency general surgery patients (EGS) having COVID19 are unknown. Our study across 52 countries demonstrates that COVID19 patients undergoing EGS have higher mortality and pulmonary complications especially in the presence of preoperative respiratory findings.

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery

“…We demonstrated an increased risk of 30-day adverse events in COVID-19-positive patients undergoing hip and knee arthroplasty and trauma surgery. While there appears to be consensus on increased risk of perioperative complications in trauma surgery in COVID-19-positive patients, 16 , 27 , 44 , 45 our results with regard to joint arthroplasty are in contrast to some recent reports arguing COVID-19 positivity does not significantly increase risk of respiratory, infectious, cardiac, and thromboembolic complications. 46 , 47 These differences may again be explained by the quality and size of studied databases and retrospective nature of analyses.…”

Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis

“… 28 , 29 In contrast, another study focusing on patients undergoing select emergency general surgery procedures found that the higher risk of 30-day mortality and pulmonary complications is only notable in patients who had preoperative respiratory clinical or radiological findings of SARS-CoV-2 infection. 30 …”

Nonelective coronary artery bypass graft outcomes are adversely impacted by Coronavirus disease 2019 infection, but not altered processes of care: A National COVID Cohort Collaborative and National Surgery Quality Improvement Program analysis

“… 9 , 10 , 27 , 28 , 29 , 30 In agreement with this analysis, active COVID-19 infection in patients undergoing urgent or emergent surgical procedures appears to confer an increased risk of perioperative morbidity and mortality. 31 , 32 , 33 , 34 Indeed, Knisely and colleagues' 33 recent examination of COVID-19 patients demonstrated that those undergoing urgent and emergent surgical procedures were at increased risk of severe complications regardless of preoperative American Society of Anesthesiologists category, with a reported risk ratio for death in active COVID-19 patients of 55.00 for those undergoing urgent surgical procedures. These findings have been echoed by other large cohort analyses.…”

“…These findings have been echoed by other large cohort analyses. 31 , 32 , 34 Nonelective coronary bypass in the setting of COVID-19 infection poses a unique challenge to cardiac surgeons not only for the inherent risks of an urgent or emergent procedure, but also for the confounder of a significant active respiratory illness. This study highlights the increased risks associated with nonelective CABG in COVID-19 active patients and suggests careful consideration should be given to the management of these patients to optimize outcomes.…”