Outcomes of COVID-19 patients that needed emergency general surgery: predictors of mortality and postoperative complications

Abstract

Abstract Purpose There is limited data about the perioperative outcomes of COVID−19 patients that needed emergency general surgery. The aims of the present study were to describe the perioperative outcomes of COVID−19 patients that underwent emergency general surgery and to determine possible predictors of mortality and postoperative complications. Methods A prospective study of positive COVID−19 patients that needed an emergency general surgery procedure at our center was performed. Results From March 2020 to February 2021, 44 patients were included. We found that patients with SARS-CoV−2 symptomatic disease have increased postoperative complications, higher ICU admissions, prolonged length of stay, and decreased 90-day survival 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 symptoms 63.4% (50.5–76.2). We found the following cut-off values for the prediction of mortality: ferritin ≥ 438.5 ng/mL (AUC = 0.908), CRP value ≥ 12.5 mg/dL (AUC = 0.715), leukocyte ≥ 13.8 x103/µL (AUC = 0.706), and albumin ≤ 2.78 g/dL (AUC = 704,). Also, 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 that needed emergency surgery have increased postoperative complications, higher ICU admissions, prolonged length of stay, 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.