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

2021; Oxford University Press; Volume: 108; Issue: 12 Linguagem: Inglês

10.1093/bjs/znab299

1365-2168

Javier Osorio, Zoilo Madrazo González, S Videla, Beatriz Sainz, Araceli Rodríguez-González, Andrea Campos‐Serra, Maite Santamaría, Amalia Pelegrina, Carmen González-Serrano, Aurora Aldeano, Aingeru Sarriugarte Lasarte, Carlos Javier Gómez-Díaz, David Ruiz-Luna, Amador García Ruiz de Gordejuela, Concepción Gómez‐Gavara, Marta Gil-Barrionuevo, Marina Vila, Arantxa Clavell, Beatriz Campillo, Laura Sebastián Millán, Carles Olona, Sergi Sánchez-Cordero, R Medrano, Camilo Lopez‐Arevalo, Noelia Pérez, Eva Artigau, M.C. Martín Calle, Victor Echenagusía, Aurema Otero, Cristian Tebé, Natàlia Pallarès, Sebastiano Biondo, M J Sara, Aitor Ariceta, R Ruiz-Marzo, Alana Thais Gisch Andres, L Arrabal, Alba Garcia-Trancho, Anna Muñoz-Campaña, Arturo Cruz Cidoncha, Victor Lucas, N Mestres, Jesús Ramírez-Ortega, S. Pérez-Farre, Estela Membrilla, A. Morera, Esther Baena, N. Cornellà, J I Uriarte, E Gonzalez-Aguirregomezcorta, M Amarelo, Nancy Alva Arroyo, Montserrat Batlle, M Flores, E Alonso, M Esgueva, Ibabe Villalabeitia, C A Guariglia, Alexander Osorio, L Sanchón, Carlos Petrola, Rubén Ángel Martín-Sánchez, M. Moratal, Pierre Clos, Elisenda Garsot, Arnaldo Aldama Caballero, John del Corral, A. Romero, Andrea O. Rossetti, E Vaillo, A Caro, Robert Memba, Rosa Jorba, Daniel E. Salazar, C Galmés, M Artigot, S Rofín, L M Escobar, Marcelo Rázquin Arias, Cristina Benaiges, Edward Maldonado,

Cardiac, Anesthesia and Surgical Outcomes

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.