TY - JOUR
T1 - Mortality and pulmonary complications in emergency general surgery patients with COVID-19
T2 - A large international multicenter study
AU - COVIDSurg Collaborative
AU - Gebran, Anthony
AU - Gaitanidis, Apostolos
AU - Argandykov, Dias
AU - Maurer, Lydia R.
AU - Gallastegi, Ander Dorken
AU - Bokenkamp, Mary
AU - Alser, Osaid
AU - Nepogodiev, Dmitri
AU - Bhangu, Aneel
AU - Kaafarani, Haytham M.A.
AU - Study group members AMC, null
AU - Scheijmans, Jochem C. G.
AU - Boermeester, Marie A.
AU - Hompes, Roel
AU - Meima - van Praag, Elise M.
AU - Mokhtarzadeh Sharabiany, Sarah
N1 - Funding Information: This study was funded by the National Institute for Health Research, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynecological Cancer Society, European Society of Coloproctology, National Institute for Health Research Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. The funding bodies have no rule in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. DISCLOSURE Publisher Copyright: © Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - OBJECTIVES 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. METHODS All patients 17 years or older and diagnosed preoperatively with COVID-19 between February and July 2020 were included. Emergency general surgery 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, or 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). RESULTS 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 of 1,045 patients), and the overall pulmonary complication rate was 32.9% (344 of 1,045 patients); in the subgroup of laparotomy patients, the rates were 30.6% (134 of 438 patients) and 59.2% (260 of 439 patients), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings. CONCLUSION 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. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
AB - OBJECTIVES 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. METHODS All patients 17 years or older and diagnosed preoperatively with COVID-19 between February and July 2020 were included. Emergency general surgery 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, or 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). RESULTS 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 of 1,045 patients), and the overall pulmonary complication rate was 32.9% (344 of 1,045 patients); in the subgroup of laparotomy patients, the rates were 30.6% (134 of 438 patients) and 59.2% (260 of 439 patients), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings. CONCLUSION 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. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
KW - COVID-19
KW - COVIDSurg
KW - emergency surgery
KW - mortality
KW - pulmonary complications
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U2 - https://doi.org/10.1097/TA.0000000000003577
DO - https://doi.org/10.1097/TA.0000000000003577
M3 - Article
C2 - 35195098
SN - 2163-0755
VL - 93
SP - 59
EP - 65
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -