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. 2021 Jun;47(3):693-702.
doi: 10.1007/s00068-020-01558-z. Epub 2021 Jan 5.

Overall management of emergency general surgery patients during the surge of the COVID-19 pandemic: an analysis of procedures and outcomes from a teaching hospital at the worst hit area in Spain

Fernández-Martínez María  1 , Martín-Román Lorena  2 , Fernández-Vázquez María Luz  2 , Rey-Valcarcel Cristina  2 , Pérez-Díaz Dolores  2 , Turégano-Fuentes Fernando  2
Affiliations

Overall management of emergency general surgery patients during the surge of the COVID-19 pandemic: an analysis of procedures and outcomes from a teaching hospital at the worst hit area in Spain

Fernández-Martínez María et al. Eur J Trauma Emerg Surg. 2021 Jun.

Abstract

Objective: To assess how the COVID-19 outbreak has affected emergency general surgery (EGS) care during the pandemic, indications for surgery, types of procedures, perioperative course, and final outcomes.

Methods: This is a retrospective study of EGS patients during the pandemic period. The main outcome was 30-day morbidity and mortality according to severity and COVID-19 infection status. Secondary outcomes were changes in overall management. A logistic regression analysis was done to assess factors predictive of mortality.

Results: One hundred and fifty-three patients were included. Half of the patients with an abdominal ultrasound and/or CT scan had signs of severity at diagnosis, four times higher than the previous year. Non-COVID patients underwent surgery more often than the COVID group. Over 1/3 of 100 operated patients had postoperative morbidity, versus only 15% the previous year. The most common complications were septic shock, pneumonia, and ARDS. ICU care was required in 17% of patients, and was most often required in the SARS-CoV-2-infected group, which also had a higher morbidity and mortality. The 30-day mortality in the surgical series was of 7%, with no differences with the previous year. The strongest independent predictors of overall mortality were age > 70 years, ASA III-IV, ESS > 9, and SARS-CoV-2 infection.

Conclusions: Non-operative management (NOM) was undertaken in a third of patients, and only 14% of operated patients had a perioperative confirmation of -CoV-2 infection. The severity and morbidity of COVID-19-infected patients was much higher. Late presentations for medical care may have added to the high morbidity of the series.

Keywords: COVID-19; Emergency surgery; General surgery.

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Conflict of interest statement

No conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Postoperative morbidity of the series* as compared to the same period of time of the previous year. *: only operated patients. NOMI: non-occlusive mesenteric ischemia. SB small bowel, ARDS Acute Respiratory Distress Syndrome, F.B. foreign body
See this image and copyright information in PMC

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