Hepatopancreatobiliary surgery in a Mexican social security hospital during the COVID-19 pandemic.

INTRODUCTION: Data on hepatopancreatobiliary (HPB) surgery and COVID-19 are scarce. The objective of the study was to determine the outcomes HPB procedures during the COVID-19 pandemic and compare results to the previous year. METHODS: IRB approved study of HPB procedures (April, 2020-November, 2020). Primary endpoints: Thirty-day surgical morbidity/mortality, including COVID-19 infection. Secondary endpoints: Comparison between 2019 and 2020 procedures. RESULTS: Twenty-five patients were included. In 2020, HPB procedures decreased 31.6%. About 60% developed complications (Clavien-Dindo Grade III, 20%). Three patients developed post-operative COVID-19 infection (two deaths: 66% COVID-19 mortality). When compared to the previous year, there were more emergency cases, ventilator-assisted patients (p < 0.05) and pre-operative acute renal failure (p = 0.06). Clavien-Dindo complication grades were higher in 2020. Thirty-day mortality was also higher (16% vs. 5.6%). CONCLUSION: HPB surgical activity was negatively influenced by COVID-19 on 30-day morbidity/mortality. HPB patients who developed post-operative COVID-19 infection had a complicated course with significant mortality.

OBJETIVO: Los datos sobre cirugía hepatopancreatobiliar (HPB) y COVID-19 son escasos. El objetivo del estudio fue determinar los resultados de procedimientos de HPB durante la pandemia COVID-19 y comparar resultados con el año anterior. MATERIAL-MÉTODOS: Estudio de procedimientos HPB aprobado por el IRB (04/2020-11/2020). Criterios de valoración principales: morbilidad/mortalidad quirúrgica a los 30 días, incluida la infección por COVID-19. Criterios de valoración secundarios: comparación entre los procedimientos de 2019 y 2020. RESULTADOS: Se incluyeron 25 pacientes. En 2020, los procedimientos de HPB disminuyeron 31.6%. El 60% desarrolló complicaciones (grado III de Clavien-Dindo, 20%). 3 pacientes desarrollaron infección posoperatoria por COVID-19, (2 muertes: 66% de mortalidad por COVID-19). En comparación con el año anterior, hubo más casos de emergencia, pacientes asistidos por ventilador (p < 0.05) e insuficiencia renal aguda preoperatoria (p = 0.06). Los grados de complicación de Clavien-Dindo fueron más altos en 2020. La mortalidad a 30 días también fue más alta (16% frente a 5.6%). CONCLUSIÓN: La actividad quirúrgica de HPB fue influenciada negativamente por COVID-19 en la morbilidad/mortalidad a 30 días. Los pacientes con HPB que desarrollaron infección posoperatoria por COVID-19 tuvieron un curso complicado con una mortalidad significativa.

Surgical Outcomes During COVID-19 Pandemic.

BACKGROUND: In December 2019, an outbreak of a novel coronavirus (COVID-19) occurred in China and became pandemic in March 2020. Patients undergoing surgery are a vulnerable risk of COVID-19 exposure/infection. The aim of the study was to determine the characteristics and outcomes of patients undergoing surgery during the COVID-19 pandemic in a third level reference hospital in Mexico. METHOD: IRB approved observational study (prospectively collected database) of general and surgical oncology procedures from 04/20-08/20. Patients preoperative data and surgical cases registered. COVID-19 detection was a combination of polymerase chain reaction swab and chest computed tomography. Primary endpoints were: 30 d surgical mortality and complications, including COVID-19 infection during hospitalization. RESULTS: 193 patients were included (mean age: 53.9 years, 63.7% female). 52.8% procedures were performed by surgical oncology. 42.4% developed a complication with 8.3% mortality. COVID-19 infection was 11.3% (n = 22). Postoperative morbidity (81.3 vs. 37.4%, p = 0.0001) and mortality (27.3 vs. 5.8%, p = 0.0001) was higher in COVID-19 (+) patients. Factors associated with COVID-19 infections were sex, functional status, preoperative sepsis and ventilation, renal failure and dialysis (univariate analysis) and sepsis and renal failure (multivariate analysis). COVID-19 infection was associated with respiratory complications (54.5 vs. 2.9%), surgical site infection (27.3 vs. 10.5%), postoperative transfusions (59.1 vs. 31.6%), renal failure (54.5 vs. 8.2%), sepsis (68.2 vs. 22.2%), reintervention (22.7 vs. 7.6%), readmission (18.2 vs. 4.1%), and death (27.3 vs. 5.8%) (p <0.05). CONCLUSION: Postoperative morbidity and mortality in COVID-19 patients is high. Surgical procedures should be thoughtfully reviewed with a plan to minimize scheduled operations.