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Inicio Cirugía Española (English Edition) Evolutionary analysis of patient’s morbidity and mortality in emergency surgic...
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Vol. 101. Issue 8.
Pages 538-547 (August 2023)
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Vol. 101. Issue 8.
Pages 538-547 (August 2023)
Original article
Evolutionary analysis of patient’s morbidity and mortality in emergency surgical care during the pandemic: Retrospective comparison between first and second waves of COVID-19
Análisis evolutivo de morbimortalidad en cirugía de urgencias durante la pandemia: comparación retrospectiva entre primera y segunda ola de COVID-19
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Carlos Bustamante Recuencoa,
Corresponding author
esthermcpm@gmail.com

Corresponding author.
, Esther María Cano Pecharromána, Gloria María Mendoza Esparrellb, Mahur Esmailli Ramosb, Javier Broekhuizen Benítezb, Leticia Martín Paniaguab, Teresa Calderón Duquec, Tomás Balsa Marínd
a Servicio FEA Cirugıía General y del Aparato digestivo, Hospital Nuestra Senóra del Prado, Toledo, Spain
b Servicio Cirugıía General y del Aparato digestivo, Hospital Nuestra Senóra del Prado, Toledo, Spain
c Sección Unidad Coloproctologıía Cirugıía General y del Aparato digestivo, Hospital Nuestra Sen óra del Prado, Toledo, Spain
d Servicio Cirugıía General y del Aparato digestivo, Hospital Nuestra Senóra del Prado, Toledo, Spain
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Tables (3)
Table 1. Demographic characteristics of the study sample.
Table 2. General therapeutic management, morbidity and mortality in the sample studied.
Table 3. General and comparative analysis of risk factors for morbidity and mortality.
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Abstract
Introduction

Since the beginning of the pandemic, morbidity and mortality in emergency care of surgical patients have been the subject of several studies. However, most of these have compared this variable with that of the pre-COVID period, ignoring its evolution during the pandemic itself. In order to analyze this possible change, we performed a comparative study of morbidity and mortality in emergency surgery between the first and second waves of the pandemic in our center.

Methods

Retrospective longitudinal study including all patients over the age of 18 admitted and/or operated in the emergency setting in the two maximum incidence periods (MIP) of COVID-19 infection (1st MIP: 22/03/2020-31/05/2020; 2nd MIP: 26/08/2020-30/11/2020). The incidence of SARS-CoV-2 infection, treatment received, early morbidity and mortality and possible risk factors for complications were analyzed.

Results

A total of 173 patients were analyzed (1st MIP: 66; 2nd MIP: 107). The incidence of COVID-19 was higher in the second period (14.95% vs. 4.54%). SARS-CoV-2 infection was associated with a higher rate of complications; however, no statistically significant differences were observed in morbimortality rate, either in the total sample (P = .746) or in patients with a positive COVID-19 test (P = .582) between both periods. Surgical treatment was found to be associated with a lower complication rate in both the first (P = .006) and second waves (P = .014), and it was more frequent in the second MIP (70.1% vs 57.6%), although statistical significance was not reached (P = .065).

Conclusions

No significant differences were observed in morbidity and mortality of patients admitted and/or operated in the emergency setting in the two periods of maximum incidence of SARS-CoV-2 at our center. Surgical treatment was associated with lower morbidity and mortality rates, and it was more frequent in the second MIP.

Keywords:
SARS-CoV-2
COVID-19
Emergency surgery
Morbimortality
Resumen
Introducción

Desde el comienzo de la pandemia, la morbimortalidad en la atención urgente al paciente quirúrgico ha sido objeto de estudio. Sin embargo, la mayoría de los estudios compararon dicha variable con la propia de la época pre-COVID, obviando la evolución de la misma durante la propia pandemia. Con el objetivo de analizar este posible cambio, realizamos un estudio comparativo de morbimortalidad en cirugía de urgencias entre la primera y segunda ola de la pandemia en nuestro centro.

Material y métodos

Estudio retrospectivo longitudinal que incluyó a todos los pacientes mayores de 18 años ingresados y/o intervenidos quirúrgicamente de forma urgente en los dos períodos de máxima incidencia (PMI) de infección por COVID-19 (1ºPMI: 22/03/2020-31/05/2020; 2ªPMI: 26/08/2020-30/11/2020). Se analizó la incidencia de infección por SARS-CoV2, el tratamiento recibido, la morbimortalidad precoz y los posibles factores de riesgo de complicaciones.

Resultados

Se analizaron 173 pacientes (1ºPMI: 66; 2ºPMI: 107). La incidencia de COVID-19 fue mayor en el segundo periodo (14,95% vs. 4,54%). La infección por SARS-CoV-2 se asoció a una mayor tasa de complicaciones, sin embargo, no se observaron diferencias estadísticamente significativas en la morbimortalidad general (p = 0,746) ni en la de los pacientes COVID positivos (p = 0,582) entre ambos períodos. El tratamiento quirúrgico se asoció con una menor tasa de complicaciones tanto en la primera (p = 0,006) como en la segunda ola (p = 0,014). Dicho tratamiento quirúrgico fue más frecuente en el segundo PMI (70,1% vs 57,6%) aunque no se alcanzó la significación estadística al respecto de esta afirmación (p = 0,065).

Conclusiones

No se observaron diferencias significativas en la morbimortalidad de los pacientes ingresados y/o intervenidos quirúrgicamente de urgencias en los dos períodos de máxima incidencia de SARS-CoV-2 en nuestro centro. El tratamiento quirúrgico se asoció con una menor morbimortalidad, siendo este más frecuente en el segundo PMI.

Palabras clave:
SARS-CoV-2
COVID-19
Cirugía de urgencias
Morbimortalidad

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