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Crovari F, Inzunza M, Irarrázaval MJ, Romero C, Achurra P, Quezada N, Gabrielli M, Muñoz R. Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center. Obes Surg 2021; 31:5376-5382. [PMID: 34482520 PMCID: PMC8418454 DOI: 10.1007/s11695-021-05695-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic. OBJECTIVES To determine the risk of symptomatic COVID-19 infection and associated complications during the first 30 days after bariatric surgery. MATERIALS AND METHODS Prospective observational cohort study including all patients who consecutively underwent primary bariatric surgery between August and December 2020. RESULTS A total of 189 patients were included. Median age and BMI were 36 (17-70) years and 38 (35-41) kg/m2, respectively. Forty percent of patients were women (n = 76), 59.3% (n = 112) underwent sleeve gastrectomy (SG), and 40.7% (n = 77) underwent Roux-en-Y gastric bypass (RYGB). All surgeries were performed laparoscopically. The median length of postoperative stay was 2 (0-5) days. Postoperative COVID-19 infection was detected in two patients (1.1%): one patient was readmitted without the need of intermediate or ICU care, and the other was managed as an outpatient. Major complications occurred in three patients (1.6%); none of them was COVID-19 related. Two patients required an unplanned reoperation. No patient required intermediate or ICU care, no severe COVID-19 complications were observed, and no mortality was reported. CONCLUSION Bariatric surgery can be safely performed during the ongoing pandemic, albeit a low risk of COVID-19 symptomatic infection. Rigorous perioperative COVID-19 institutional protocols are required to perform bariatric surgery safely during the current pandemic.
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Affiliation(s)
- Fernando Crovari
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María J Irarrázaval
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Romero
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- , Santiago, Chile.
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Osorio J, Madrazo Z, Videla S, Sainz B, Rodríguez-González A, Campos A, Santamaría M, Pelegrina A, González-Serrano C, Aldeano A, Sarriugarte A, Gómez-Díaz CJ, Ruiz-Luna D, García-Ruiz-de-Gordejuela A, Gómez-Gavara C, Gil-Barrionuevo M, Vila M, Clavell A, Campillo B, Millán L, Olona C, Sánchez-Cordero S, Medrano R, López-Arévalo CA, Pérez-Romero N, Artigau E, Calle M, Echenagusia V, Otero A, Tebe C, Pallares N, Biondo S. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic. Br J Surg 2021; 108:1438-1447. [PMID: 34535796 DOI: 10.1093/bjs/znab299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. METHODS Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. RESULTS Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. CONCLUSION Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.
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Affiliation(s)
- J Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Z Madrazo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - S Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - B Sainz
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - A Campos
- Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain
| | - M Santamaría
- Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain
| | - A Pelegrina
- Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain
| | | | - A Aldeano
- Department of Surgery, Granollers General Hospital, Granollers, Spain
| | - A Sarriugarte
- Department of Surgery, Cruces University Hospital, Bilbao, Spain
| | - C J Gómez-Díaz
- Department of Surgery, Althaia Foundation, Manresa, Spain
| | - D Ruiz-Luna
- Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain
| | | | - C Gómez-Gavara
- Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - M Vila
- Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain
| | - A Clavell
- Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - B Campillo
- Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain
| | - L Millán
- Department of Surgery, Dr José Molina Orosa Hospital, Lanzarote, Spain
| | - C Olona
- Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain
| | - S Sánchez-Cordero
- Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain
| | - R Medrano
- Department of Surgery, Sant Pau University Hospital, Barcelona, Spain
| | - C A López-Arévalo
- Department of Surgery, Moisès Broggi Hospital, Sant Joan Despí, Spain
| | - N Pérez-Romero
- Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain
| | - E Artigau
- Department of Surgery, Girona Dr Josep Trueta University Hospital, Girona, Spain
| | - M Calle
- Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain
| | - V Echenagusia
- Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain
| | - A Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Tebe
- Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Pallares
- Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
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Inzunza M, Romero C, Irarrázaval MJ, Ruiz-Esquide M, Achurra P, Quezada N, Crovari F, Muñoz R. Morbidity and Mortality in Patients with Perioperative COVID-19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery. World J Surg 2021; 45:1652-1662. [PMID: 33748925 PMCID: PMC7982273 DOI: 10.1007/s00268-021-06068-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/27/2022]
Abstract
Background Severe acute respiratory syndrome due to coronavirus 2 has rapidly spread worldwide in an unprecedented pandemic. Patients with an ongoing COVID-19 infection requiring surgery have higher risk of mortality and complications. This study describes the mortality and morbidity in patients with perioperative COVID-19 infection undergoing elective and emergency surgeries. Methods Prospective cohort of consecutive patients who required a general, gastroesophageal, hepatobiliary, colorectal, or emergency surgery during COVID-19 pandemic at an academic teaching hospital. The primary outcome was 30-day mortality and major complications. Secondary outcomes were specific respiratory mortality and complications. Results A total of 701 patients underwent surgery, 39 (5.6%) with a perioperative COVID-19 infection. 30-day mortality was 12.8% and 1.4% in patients with and without COVID-19 infection, respectively (p < 0.001). Major surgical complications occurred in 25.6% and 6.8% in patients with and without COVID-19 infection, respectively (p < 0.001). Respiratory complications occurred in 30.8% and 1.4% in patients with and without COVID-19 infection, respectively (p < 0.001). Mortality due to a respiratory complication was 100% and 11.1% in patients with and without COVID-19 infection, respectively (p < 0.006). Conclusions 30-day mortality and surgical complications are higher in patients with perioperative COVID-19 infection. Indications for elective surgery need to be reserved for non-deferrable procedures in order to avoid unnecessary risks of non-urgent procedures.
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Affiliation(s)
- Martin Inzunza
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Romero
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Pablo Achurra
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile. .,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Madrazo Z, Osorio J, Otero A, Biondo S, Videla S. Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic: A multicenter collaborative retrospective cohort study protocol (COVID-CIR). Medicine (Baltimore) 2021; 100:e24409. [PMID: 33592888 PMCID: PMC7870207 DOI: 10.1097/md.0000000000024409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
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Affiliation(s)
- Zoilo Madrazo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Javier Osorio
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Aurema Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Sebastian Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
- Department of Pathology and Experimental Therapeutics, Faculty of Medicine, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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