Patients with COVID-19 who undergo emergency general surgery (EGS) have significantly elevated rates of mortality and pulmonary complications, according to a study conducted by the COVIDSurg Collaborative.

“The COVID-19 pandemic continues to cause major disruption to the delivery of surgical services globally,” said Anthony Gebran, MD, the lead author and a postdoctoral research fellow at Massachusetts General Hospital, in Boston. “However, the majority of EGS procedures cannot be postponed or canceled, especially when nonoperative alternatives are deemed unacceptable in efficacy or safety.”

Yet, data remain scarce regarding the postoperative outcomes of EGS patients with preoperative COVID-19. In addition, it is unclear whether the presence, or absence, of COVID-19 symptoms affects the outcomes of EGS patients (paper 19).

In an effort to research these issues, the study authors sought to determine 30-day mortality and pulmonary complications (acute respiratory distress syndrome, unexplained postoperative mechanical ventilation or pneumonia) among EGS patients, and compare clinical outcomes of patients with and without preoperative respiratory signs or symptoms of COVID-19 infection.

The study included 1,045 patients at least 17 years of age who were diagnosed with COVID-19 at least seven days before surgery, which was defined as urgent/emergent performance of appendectomy, cholecystectomy or laparotomy. Of the patients. 61.9% had preoperative symptoms of COVID-19. Overall rates of 30-day mortality were 15%, and 30-day pulmonary complications were 32.9%.

They found that patients with COVID-19 who underwent EGS had significantly higher rates of both mortality and pulmonary complications, compared with pre-pandemic baseline levels. Among patients who underwent laparotomy, mortality was 33% among those with COVID-19 versus 14.3% without COVID-19. Cholecystectomy patients with COVID-19 had mortality rates of 19.2%, and pulmonary complication rates of 41%, compared with 0% and 4.5%, respectively. Among appendectomy patients, rates were 2.7% versus 1.5% for mortality, and 21.5% versus 3.3% for pulmonary complications among those with and without COVID-19.

Dr. Gebran, who is a member of the collaborative, noted that the research had limitations, including not being able to confirm whether mortality and pulmonary complications were due to the surgery itself, not evaluating whether the indication for EGS was related to COVID-19, and that none of the patients included in the study had been vaccinated against COVID-19 or infected with the delta or omicron variant.

He also cautioned that the findings incorrectly affect practice behaviors. “The results should not be interpreted as a recommendation against an operation in emergency surgery patients,” he said.

Disclosure: The COVIDSurg Collaborative has received funding from the Association of Coloproctology of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons, Bowel and Cancer Research, Bowel Disease Research Foundation, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, National Institute for Health Research, NIHR Academy, Sarcoma UK, Vascular Society of Great Britain and Ireland, and Yorkshire Cancer Research.