Emergency Gastrointestinal Surgery and In-hospital Mortality during COVID-19 Pandemic: Single Centre Study on Confirmed COVID-19 Patients

Abstract

Background: In the era of COVID-19 pandemic, various procedures have been carried out to prevent the virus transmission, and emergency surgery on COVID-19 patients is reconsidered and extremely challenging. One of the most common emergency procedures is gastrointestinal surgery.  Elective surgery could be reschedule later, however,  in the emergency setting, we must face to the higher risk condition for both patients and the surgeon.  Emergency surgery on confirmed positive COVID-19 has increased the post-operative morbidity and mortality.  The aim of this study is to evaluate the type of emergency gastrointestinal (GI) surgery-emergency procedure and it’s relation to in-hospital mortality related to post-operative morbidity. Materials and Methods: This is a retrospective study which would analyzes the post -operative morbidity and in hospital mortality on emergency GI surgery and positive COVID-19 patients.  This was a single centre study, conducted at GI surgery division of Moewardi General Hospital, Indonesia from April 2020 till March 2021.  All of these cases had done emergency exploratory laparotomy and already confirmed COVID-19 will be included on this study.  Type of emergency cases, post-operative morbidity and mortality will be reported.  The redo surgery will be excluded from this study. Result: During 1 year period of study, we reported 39 emergency GI surgery cases.  All of them has been done emergency exploratory laparotomy.  The most common procedure is diffuse peritonitis due to complicated appendicitis (reported in 21 cases), Others procedures are peptic ulcer perforations (9 cases), blunt abdominal trauma (2 cases), intestinal obstruction was found in 4 cases and 3 cases of incarcerated inguinal hernia.  Thirty one patients had survived following the emergency GI surgery and 8 patients did not survive. These patients had post-operative pneumonia and prolonged sepsis in the intensive care unit. Conclusion: Emergency GI surgery on confirmed COVID-19 patients, are still challenging and has special consideration on post-operative morbidity, which leads to increased post-operative mortality rates. Although, it is a high risk procedure, multidisciplinary team should always be aware of the risk and benefit of treating emergency cases especially when facing the current pandemic of COVID-19.