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

Dra Mariel González-Calatayud; Dr Benito Vargas-Ábrego; Dra Gabriela E Gutiérrez-Uvalle; Dra Sandra C López-Romero; Dr Luis Gabriel González-Pérez; Dr José Alberto Carranco-Martínez; Dr Jed Raful-Zacarías-Ezzat; Dr Noé I Gracida-Mancilla

doi:10.1016/j.amsu.2020.10.038

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 Dec:60:149-154. doi: 10.1016/j.amsu.2020.10.038. Epub 2020 Oct 24.

Authors

Dra Mariel González-Calatayud¹, Dr Benito Vargas-Ábrego², Dra Gabriela E Gutiérrez-Uvalle³, Dra Sandra C López-Romero³, Dr Luis Gabriel González-Pérez³, Dr José Alberto Carranco-Martínez⁴, Dr Jed Raful-Zacarías-Ezzat⁵, Dr Noé I Gracida-Mancilla³

Affiliations

¹ Surgical Therapeutics Service of the Hospital General de México "Dr. Eduardo Liceaga", Mexico.
² Thorax Surgery Service in Charge of Tracheotomies at the Hospital General de México "Dr. Eduardo Liceaga", Mexico.
³ Acute Surgical Pathology Service of the Hospital General de México "Dr. Eduardo Liceaga", Mexico.
⁴ Obstetrics-Gynecology / Maternal-Fetal Medicine Service of the General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico.
⁵ Surgical Director of the Hospital General de México "Dr. Eduardo Liceaga", México.

Abstract

Approximately 28, 404, 603 surgical events have been suspended in the 12 peak weeks of the COVID-19 pandemic. The aim of this study was to report all the surgically intervened patients with suspected or confirmed SARS CoV-2 infection from April 1 to July 31, 2020, and to estimate their prognosis in the Surgical Therapy Department of a third level hospital in Mexico.

Method: We conducted an observational study of patients undergoing surgical intervention in the operating room assigned as COVID, where we considered age, sex, treating department, type of intervention, and initial biomarkers (first five days of hospitalization), days of hospital stay, days in the Intensive Care Unit and reason for discharge.

Results: 42 patients have been surgically intervened, with a total of 49 surgeries. For Otolaringology and General Surgery, there were more deceased cases than alive cases; while for Thoracic Surgery, and Obstetrics and Gynecology, there were more alive cases than deceased ones (36% and 0% deceased, respectively), with statistically significant differences (p = 0.014). With regard to mortality for each group of surgical procedure, patients who underwent C-section or pleurostomy had a mortality rate of 0%; the mortality rate for patients who underwent tracheostomy was 52%; patients who underwent laparotomy had a mortality rate of 54%; for those who underwent debridement, the mortality rate was 100%; which show significant differences, with a p value of 0.03.

Discussion: we identified an overall mortality rate of 42.8%, with a significant difference between treating departments and type of surgical procedure. This can be explained because many of the General Surgery patients, in addition to their infectious process by COVID-19, had another complication, like sepsis, In the same way, we can say that pregnant patients are healthy and have a physiological condition. Finally, patients undergoing an open tracheostomy had solely pulmonary complications.

Conclusion: There is no doubt that we face an unknown condition for which we have been learning tests along the way. This sample of cases undergoing surgery at the beginning of the COVID-19 pandemic can provide clues on relevant results that we must consider for future cases.

Keywords: COVID 19 pandemic; Emergency surgery; SARS-CoV 2 infection; Surgical procedures.