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.

中文翻译：

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COVID-19 大流行期间急诊普通和胃肠手术的结果分析

摘要 背景很少有外科研究提供了当代感染和未感染 COVID-19 的患者以及大流行前接受治疗的患者的调整后的术后结果比较数据。本研究的目的是确定对合并 COVID-19 感染的患者进行紧急手术的影响。 方法一项回顾性研究 (COVID-CIR) 纳入了 2020 年 3 月至 6 月以及 2019 年 3 月至 6 月在 25 家西班牙医院接受急诊普通和胃肠手术的患者。主要结果是 30 天死亡率。次要结局包括术后并发症和抢救失败（出现并发症的患者死亡率）。对 COVID-19 阳性患者和阴性患者进行倾向评分匹配比较；以及大流行之前和期间的 COVID-19 阴性队列之间的比较。 结果该研究纳入了约 5307 名患者（大流行期间 183 名 COVID-19 阳性患者和 2132 名 COVID-19 阴性患者；2992 名患者在大流行前接受治疗）。在大流行期间，感染了 COVID-19 的患者的 30 天死亡率高于未感染的患者（12.6% vs 4.6%），但在倾向评分匹配后，这种差异并不具有统计学意义（比值比 (OR) 1.58，95% ci 0.88 至 2.74）。COVID-19 呈阳性的患者并发症较多（41.5% vs 23.9%；OR 1.61、1.11 至 2.33），且抢救失败的可能性更高（30.3% vs 19.3%；OR 1.10、0.57 至 2.12）。大流行期间 COVID-19 呈阴性的患者的 30 天死亡率（4.6% vs 3.2%；OR 1.35，0.98 至 1.86）和并发症率相似（23.9% vs 25.2%；OR 0.89，0.77 至 1.02），但与大流行前的对照相比，救援失败的可能性更大（19.3％对12.9％；OR 1.56，95％1.10至2.19）。 结论接受紧急普通和胃肠手术的 COVID-19 感染患者的术后结果比当代未感染 COVID-19 的患者更差。在 COVID-19 大流行期间接受手术的 COVID-19 阴性患者比大流行前的对照患者更有可能出现抢救失败的情况。