Acil Abdominal Cerrahi Yapılan COVID-19 Hastalarında Postoperatif Komplikasyonların Öngördürücüleri

Abstract

Amaç: COVID-19 dünya çapında hızla yayılması ve pandemi haline gelmesi, cerrahi hastalarda postoperatif komplikasyonların insidansında da artışa neden oldu. Acil ameliyata alınan hastalarda COVID-19 pozitifliğinin ameliyat sonrası komplikasyonları etkileyebileceği açıktır. Bu çalışmada acil abdominal cerrahi uygulanan COVID-19 hastalarında postoperatif komplikasyonlar için öngördürücü faktörlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada acil abdominal cerrahi uygulanan ve perioperatif 72 saat içerisinde COVID-19 Polimeraz Zincir Reaksiyonu (PCR) testi pozitif sonuçlanan 52 hasta retrospektif olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen hastaların medyan yaşı 50.5’di (aralık: 18-83). 30 günlük mortalite oranı %15.4 olarak saptandı. Postoperatif komplikasyon oranı %23.1’di. Postoperatif komplikasyon durumu ile yaş (p=0.003) ve preoperatif hemoglobin değeri (p=0.001) arasında anlamlı bir ilişki saptandı. Yaş ve hemoglobinin birlikte değerlendirilmesinin postoperatif komplikasyonlar için sensivitesinin %91.7, spesifitesinin %87.5 olduğu görüldü (p<0.001, AUC: 0.867). Ayrıca ameliyat öncesi hemoglobin değeri ile hastanede kalış süresi arasında negatif korelasyon saptandı (p<0.001). Sonuç: COVID-19 testi pozitif olan ve acil abdominal cerrahi uygulanan hastalar önemli bir postoperatif komplikasyon riski ile karşı karşıyadır. Bu hastalarda ileri yaş ve düşük hemoglobin düzeyleri postoperatif komplikasyonlar için öngördürücü olabilir.

Keywords

• COVID-19; abdominal cerrahi
• acil cerrahi
• postoperatif komplikasyonlar

Supporting Institution

Funding: None

Ethical Statement

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its subsequent amendments or similar ethical standards. No animal or human studies were performed by the authors for this article.

Thanks

There is no acknowledgments.

Predictors of Postoperative Complications in COVID-19 Patients Undergoing Emergency Abdominal Surgery

Abstract

Aim: The rapid spread of COVID-19 worldwide has also caused an increase in the incidence of postoperative complications in surgical patients. Clearly, COVID-19 positivity may affect postoperative complications in patients undergoing emergency surgeries. This study aimed to evaluate the factors predictive of postoperative complications in COVID-19 patients undergoing emergency abdominal surgeries. Material and Methods: Fifty-two patients who underwent emergency abdominal surgeries and tested positive for COVID-19 via a Polymerase Chain Reaction (PCR) test within 72 hours of the perioperative period were evaluated retrospectively. Results: The median age of the patients included in the study was 50.5 years (range: 18–83 years). The 30-day mortality rate was 15.4%, while the postoperative complication rate was 23.1%. A significant correlation was found between postoperative complication status and age (p = 0.003) and between postoperative complication status and preoperative hemoglobin levels (p = 0.001). The evaluation of age and hemoglobin together showed a sensitivity of 91.7% and a specificity of 87.5% for postoperative complications (p < 0.001, AUC: 0.867). In addition, a negative correlation was found between preoperative hemoglobin levels and length of hospital stay (p < 0.001). Conclusion: COVID-19-positive patients who undergo emergency abdominal surgeries face a significant risk of postoperative complications. An advanced age and low hemoglobin levels may be predictors of postoperative complications in this group of patients.

Keywords

• COVID-19; abdominal surgery
• emergency surgery
• postoperative complications

References

1. Bilinski A, Emanuel EJ. COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries. Jama, 2020; 324: 2100-2102.
2. Kasivisvanathan V, Lindsay J, Rakshani-Moghadam S, et al. A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site. International journal of surgery (London, England), 2020; 84: 57-65.
3. Jang M, Lee M, Lee G, Lee J, Choi K, Yu B. Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study. Healthcare (Basel), 2023; 11.
4. Toor SM, Saleh R, Sasidharan Nair V, Taha RZ, Elkord E. T-cell responses and therapies against SARS-CoV-2 infection. Immunology, 2021; 162: 30-43.
5. Pratha AR, Pustela MK, Kaniti VK, Shaik SB, Pecheti T. Retrospective analysis of outcome of COVID positive patients undergoing emergency surgeries for acute general surgical conditions. International Surgery Journal, 2023; 10: 432-436.
6. Hachiya K, Kawabata S, Nagai S, et al. Emergency Surgical Management of Lumbar Burst Fracture in a Patient with COVID-19: A Case Report. Spine Surg Relat Res, 2022; 6: 314-317.
7. Inzunza M, Romero C, Irarrázaval MJ, et al. Morbidity and Mortality in Patients with Perioperative COVID-19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery. World J Surg, 2021; 45: 1652-1662.
8. Deng JZ, Chan JS, Potter AL, et al. The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States. Ann Surg, 2022; 275: 242-246.

9. Doglietto F, Vezzoli M, Gheza F, et al. Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy. JAMA Surg, 2020; 155: 691-702.
10. Nepogodiev D, Bhangu A, Glasbey JC, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet, 2020; 396: 27-38.
11. Knisely A, Zhou ZN, Wu J, et al. Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures. Ann Surg, 2021; 273: 34-40.
12. Guadalajara H, Muñoz de Nova JL, Fernandez Gonzalez S, et al. Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): Surgery may be the best treatment option. Br J Surg, 2020; 107: e494-e495.
13. Seeliger B, Philouze G, Cherkaoui Z, Felli E, Mutter D, Pessaux P. Acute abdomen in patients with SARS-CoV-2 infection or co-infection. Langenbecks Arch Surg, 2020; 405: 861-866.
14. González-Calatayud DM, Vargas-Ábrego DB, Gutiérrez-Uvalle DGE, et al. Observational study of the suspected or confirmed cases of sars COV-2 infection needing emergency surgical intervention during the first months of the pandemic in a third level hospital: Case series. Ann Med Surg (Lond), 2020; 60: 149-154.
15. Osorio J, Madrazo Z, Videla S, et al. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic. Br J Surg, 2021; 108: 1438-1447.
16. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015; 102: 1314-24.
17. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet, 2011; 378: 1396-407.