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.

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.