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Postoperative complications and predictors of mortality in patients with COVID-19
Katya Bozada-Gutiérrez1, Mario Trejo-Ávila1, Mucio Moreno-Portillo1
1Division of General and Endoscopic Surgery, Hospital General "Dr. Manuel Gea González", Mexico City, Mexico.
Insights
Symptomatic coronavirus disease 2019 (COVID-19) patients undergoing emergency surgery experienced worse outcomes, including higher ICU admissions and lower survival rates. Preoperative ferritin, C-reactive protein, leukocytes, and albumin levels can predict mortality in these patients.
Area of Science:
- Medical Research
- Surgical Outcomes
- Infectious Diseases
Background:
- Limited data exists on perioperative outcomes for coronavirus disease 2019 (COVID-19) patients requiring emergency general surgery.
- Understanding these outcomes is crucial for managing surgical patients during the pandemic.
Purpose of the Study:
- To describe the perioperative outcomes and mortality of patients with COVID-19 who underwent emergency surgery.
- To identify predictors of mortality in this patient cohort.
Main Methods:
- A retrospective study was conducted on COVID-19 patients who needed emergency surgery between March 2020 and February 2022.
- Patients were categorized as symptomatic or asymptomatic for COVID-19.
Main Results:
- Symptomatic COVID-19 patients had higher ICU admissions and prolonged length of stay (LOS) compared to asymptomatic patients.
- The 90-day survival probability was 70.1% overall, significantly lower in symptomatic patients (63.4%).
- Preoperative ferritin (≥ 438.5 ng/mL), C-reactive protein (CRP) (≥ 12.5 mg/dL), leukocytes (≥ 13.8 × 10³ /mL), and albumin (≤ 2.78 g/dL) were identified as predictors of mortality.
Conclusions:
- Symptomatic COVID-19 patients undergoing emergency surgery face increased ICU admissions, prolonged LOS, and reduced 90-day survival.
- Preoperative levels of ferritin, CRP, leukocytes, and albumin serve as valuable predictors for mortality in these patients.
Background:
There are limited data about the perioperative outcomes of coronavirus disease 2019 (COVID-19) patients that needed emergency general surgery. The aim of the present study was to describe the perioperative outcomes and mortality of patients with COVID-19 who underwent emergency surgery.
Materials And Methods:
Retrospective study of COVID-19 patients symptomatic versus asymptomatic from March 2020 to February 2022 that needed an emergency surgery in a national referral hospital.
Results:
Forty-four patients were included in this study. Patients with symptomatic COVID-19 have higher ICU admissions and prolonged length of stay (LOS) as compared with asymptomatic COVID-19 patients. The 90-day survival probability of the entire cohort was 70.1% (60.3-79.9) and was significantly lower in patients with COVID-19 symptomatic 63.4% (50.5-76.2). The cut-off preoperative values for the prediction of mortality: Ferritin ≥ 438.5 ng/mL (Area under the curve [AUC] = 0.908), C-reactive protein (CRP) ≥ 12.5 mg/dL (AUC = 0.715), leukocyte ≥ 13.8 × 103/mL (AUC = 0.706), and albumin ≤ 2.78 g/dL (AUC = 704). Furthermore, a cut-off value of CRP of ≥ 12.5 mg/dL yielded an accuracy of 82.9% for the prediction of postoperative complications (p < 0.001).
Conclusion:
Patients with symptomatic COVID-19 who needed emergency surgery have higher ICU admissions, prolonged LOS, and decreased 90-day survival as compared with asymptomatic COVID-19 patients. Preoperative ferritin, CRP, leukocytes, and albumin could be used as predictors of mortality.
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