Impact of COVID-19 infection during the postoperative period in patients who underwent gastrointestinal surgery

Abstract

Abstract Background The COVID-19 pandemic has caused numerous casualties worldwide. Patients undergoing surgery are more vulnerable to infections and have a higher risk of morbidity and mortality. This study investigated the impact of COVID-19 infection during the postoperative period in patients who underwent gastrointestinal surgery. Methods This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as patients in whom SARS-CoV-2 RNA was detected by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, ASA, and emergency operation between the COVID-19-negative and -positive groups. The primary outcome was major complications. Results Following 1:2 propensity score matching, 21 and 42 COVID-19-positive and -negative patients, respectively were included in the study. Of the COVID-19-positive patients, 14 (67%) had symptoms and 11 (52%) received antiviral therapy. No significant differences were observed in the clinical characteristics of the patients. Compared to the COVID-19-negative group, the COVID-19-positive group had a higher proportion of open surgeries than minimally invasive surgeries (57 vs. 28.6%, P = 0.053). In the COVID-19-positive group, the postoperative complication rate was significantly higher than in the COVID-19-negative group (52.4 vs. 23.8%, P = 0.023). Respiratory morbidity occurred in 47.6 and 38.1% of the COVID-19-positive and -negative groups, respectively (P = 0.48). Respiratory mortality was reported in one patient in the COVID-19-positive group and in none in the COVID-19-negative group. Thirty-day mortality was 4.8% in both groups (P = 0.98). Mechanical ventilator requirement, ICU admission, and readmission rate did not significantly differ between the two groups. The median length of ICU (19 vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19-positive group. In the relative risk (RR) analyses, patients with COVID-19 had a 2.4-times higher risk of major complications than patients without COVID-19 (RR 2.37; 95% CI, 1.254–4.467; P = 0.015). Conclusion COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.