Cargando…

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

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 ou...

Descripción completa

Detalles Bibliográficos
Autores principales: María, Fernández-Martínez, Lorena, Martín-Román, María Luz, Fernández-Vázquez, Cristina, Rey-Valcarcel, Dolores, Pérez-Díaz, Fernando, Turégano-Fuentes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782559/
https://www.ncbi.nlm.nih.gov/pubmed/33399877
http://dx.doi.org/10.1007/s00068-020-01558-z
_version_ 1783631931175337984
author María, Fernández-Martínez
Lorena, Martín-Román
María Luz, Fernández-Vázquez
Cristina, Rey-Valcarcel
Dolores, Pérez-Díaz
Fernando, Turégano-Fuentes
author_facet María, Fernández-Martínez
Lorena, Martín-Román
María Luz, Fernández-Vázquez
Cristina, Rey-Valcarcel
Dolores, Pérez-Díaz
Fernando, Turégano-Fuentes
author_sort María, Fernández-Martínez
collection PubMed
description 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.
format Online
Article
Text
id pubmed-7782559
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-77825592021-01-05 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 María, Fernández-Martínez Lorena, Martín-Román María Luz, Fernández-Vázquez Cristina, Rey-Valcarcel Dolores, Pérez-Díaz Fernando, Turégano-Fuentes Eur J Trauma Emerg Surg Original Article 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. Springer Berlin Heidelberg 2021-01-05 2021 /pmc/articles/PMC7782559/ /pubmed/33399877 http://dx.doi.org/10.1007/s00068-020-01558-z Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
María, Fernández-Martínez
Lorena, Martín-Román
María Luz, Fernández-Vázquez
Cristina, Rey-Valcarcel
Dolores, Pérez-Díaz
Fernando, Turégano-Fuentes
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782559/
https://www.ncbi.nlm.nih.gov/pubmed/33399877
http://dx.doi.org/10.1007/s00068-020-01558-z
work_keys_str_mv AT mariafernandezmartinez overallmanagementofemergencygeneralsurgerypatientsduringthesurgeofthecovid19pandemicananalysisofproceduresandoutcomesfromateachinghospitalattheworsthitareainspain
AT lorenamartinroman overallmanagementofemergencygeneralsurgerypatientsduringthesurgeofthecovid19pandemicananalysisofproceduresandoutcomesfromateachinghospitalattheworsthitareainspain
AT marialuzfernandezvazquez overallmanagementofemergencygeneralsurgerypatientsduringthesurgeofthecovid19pandemicananalysisofproceduresandoutcomesfromateachinghospitalattheworsthitareainspain
AT cristinareyvalcarcel overallmanagementofemergencygeneralsurgerypatientsduringthesurgeofthecovid19pandemicananalysisofproceduresandoutcomesfromateachinghospitalattheworsthitareainspain
AT doloresperezdiaz overallmanagementofemergencygeneralsurgerypatientsduringthesurgeofthecovid19pandemicananalysisofproceduresandoutcomesfromateachinghospitalattheworsthitareainspain
AT fernandotureganofuentes overallmanagementofemergencygeneralsurgerypatientsduringthesurgeofthecovid19pandemicananalysisofproceduresandoutcomesfromateachinghospitalattheworsthitareainspain