People with COVID-19 who undergo emergency general and digestive surgery show no higher mortality rate due to this infection

- Research

Their higher mortality is attributable to them being older patients with worse underlying pathology and preoperative status, according to a study

During the first wave of the pandemic, the risk of dying after a surgical complication increased from 12.8% to 19%, probably due to the difficult situation in hospitals

These are the conclusions of a large study carried out in 25 Spanish hospitals and coordinated by the Bellvitge Hospital, which has been published in the British Journal of Surgery

A large study carried out in 25 hospitals in Spain, coordinated by specialists from Bellvitge University Hospital and IDIBELL, has shown that people with COVID-19 who undergo emergency general and digestive surgery do not have a higher mortality rate due to their COVID-19 infection.

This study, published this Saturday in the prestigious British Journal of Surgery, qualifies the conclusions of previous purely descriptive studies that had found that people who underwent surgery while being infected with COVID-19 had a much higher mortality than usual. These data had led some experts to recommend delaying or avoiding surgery in SARS-CoV-2 positive patients whenever possible.

The Bellvitge University Hospital coordinated a registry of all urgent general and digestive surgeries performed from March to June 2019 and from March to June 2020 (first wave of the pandemic) in 25 Spanish hospitals. In total, more than 5,300 patients were studied.

First, the study compared COVID-19 positive and negative patients who underwent surgery during the pandemic. Using a statistical method called propensity-score matching, which consists of matching positive patients with negative ones of similar age, baseline pathology and general condition at the time of surgery, two comparable groups were defined.

The result was that mortality in these two groups did not differ statistically significantly. Thus, the high mortality observed in COVID-19 patients who underwent surgery should be attributed to their age, underlying pathology and preoperative status, rather than to a hypothetical COVID multiplier effect on postoperative mortality.

According to Dr Javier Osorio, coordinator of the study and surgeon at the General Surgery Department of Bellvitge University Hospital, "it is clear that postponing urgent surgery is somewhat risky, so it is very important to understand how and to what extent COVID-19 infection increases postoperative mortality".

Osorio stresses that, according to the results of the study, "the fact that a patient is COVID positive should not be seen as a total barrier to surgery: the assessment of the risk of performing or postponing surgery should be based on the individual anaesthetic risk of the patient and their condition at the time of diagnosis, as it has always been done".

Another aspect of the study was to compare the pathology status of patients who underwent surgery in the year before the pandemic, in 2019, with COVID-19 negative patients who underwent surgery during the pandemic, to understand the effect of lockdown. The results found that, during the pandemic, patients did not present with more advanced peritonitis or higher inflammatory parameters. Thus, the higher mortality observed during the pandemic cannot be attributed to patients attending later to healthcare services due to lockdown.

Finally, the study evaluated the so-called failure to rescue patients (percentage of patients with postoperative complications who cannot be rescued and die as a result of the complication). The authors compared the failure to rescue COVID-19 negative patients during the pandemic and those who underwent surgery before the emergence of the coronavirus, also using propensity-score matching.

The result was that those who underwent surgery during the pandemic had the same risk of complications but a higher risk of dying as a result of the complication (19%, compared to 12.8% of those who underwent surgery in the same period in 2019). This was found in all 25 participating hospitals, and was likely due to the complicated situation of the hospitals in the context of the first wave of COVID-19.

Besides that, according to this study, 22.6% fewer emergency surgeries were performed during the period March-June 2020 than during the same period in 2019, probably due to the lower number of patients going to the emergency department during the pandemic.

According to Dr Sebastià Videla, specialist of the Clinical Pharmacology Service of Bellvitge Hospital and head of the Clinical Research Department of IDIBELL, and one of the study’s authors, "one of the lessons that this research offers us is that, if we want to reduce the number of preventable deaths in the current and possible future pandemics, we will have to improve coordination and increase public health resources".

  • biondo, osorio, videla, madrazo