Mortality & Pulmonary Complications in Emergency General Surgery Patients with Mortality COVID-19: A Large International Multicenter Study

Citation:
Gebran, A., A. Gaitanidis, D. Argandykov, L. R. Maurer, A. D. Gallastegi, M. Bokenkamp, O. Alser, D. Nepogodiev, A. Bhangu, H. M. A. Kaafarani, et al., "Mortality & Pulmonary Complications in Emergency General Surgery Patients with Mortality COVID-19: A Large International Multicenter Study", The journal of trauma and acute care surgery, February, 2022.

Abstract:

<h4>Objectives</h4>The outcomes of emergency general surgery (EGS) patients with concomitant COVID-19 infection remain unknown. With a multicenter study in 361 hospitals from 52 countries, we sought to study the mortality and pulmonary complications of COVID-19 patients undergoing EGS.<h4>Methods</h4>All patients aged ≥17 years and diagnosed preoperatively with COVID-19 between February and July 2020 were included. EGS was defined as the urgent/emergent performance of appendectomy, cholecystectomy, or laparotomy. The main outcomes were 30-day mortality and 30-day pulmonary complications (a composite of acute respiratory distress syndrome, unexpected mechanical ventilation, pneumonia). Planned subgroup analyses were performed based on presence of preoperative COVID-related respiratory findings (e.g. cough, dyspnea, need for oxygen therapy, chest radiology abnormality).<h4>Results</h4>A total of 1,045 patients were included, of which 40.1% were female and 50.0% were older than 50 years; 461 (44.1%), 145 (13.9%), and 439 (42.0%) underwent appendectomy, cholecystectomy, and laparotomy, respectively. The overall mortality rate was 15.1% (158/1,045) and the overall pulmonary complication rate was 32.9% (344/1,045); in the subgroup of laparotomy patients, the rates were 30.6% (134/438) and 59.2% (260/439), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings.<h4>Conclusion</h4>COVID-19 patients undergoing EGS have significantly high rates of mortality and pulmonary complications, but the risk is most pronounced in those with preoperative respiratory findings.<h4>Level of evidence</h4>Level III.

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