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Postoperative Morbidity and Mortality in Patients with Perioperative SARS-CoV-2 Infection – a Cohort Study

Introduction and objective: Concerning SARS-CoV-2 pandemic strict restrictions were introduced in Bulgaria comparable to other coutries worlwide in terms of elective surgical care with cancellation of all but emergency surgery. The aim of this study is to report results of COVID-19-positive patients in terms of postoperative morbidity and mortality following elective and emergency surgery. Material and methods: We performed a prospective cohort study of patients who underwent elective or emergency surgery at First Clinic of Abdominal Surgery, Military Medical Academy, Sofia between November 11, 2020 and January 11, 2021. For the same period the clinic was remodeled to a combined surgical and therapeutic unit for treatment of COVID-19 patients. Results: Twenty-five patients with SARS-CoV-2 underwent surgery or were postoperatively treated between November 11, 2020 and January 11, 2021 at First Clinic of Abdominal Surgery, Military Medical Academy, Sofia – 15 male and 10 female, median age of 66.2 years (43-95). There were 5 (20%) elective oncological operations and 20 (80%) emergency procedures. Pulmonary complications were registered in 18/25 (72%) of the patients and cardio-vascular – at 3/25 (12%). Postoperative morbidity was 16% - postoperative hemorrhage (n=2), surgical site infection (n=1) and postoperative pancreatic fistula type B (n=1). Eleven patients were admitted to intensive care unit. Early postoperative mortality was 24%. Median age of deceased was 69.5 years (55- 82), 83.33 % males. There was comorbidity in 100 % of lethal cases. The main cause of mortality was COVID-19 associated. Conclusions: A SARS-CoV-2 positive status increases postoperative morbidity and mortality rates in patients undergoing general and oncological operative care. If possible, elective abdominal surgery in COVID-19 patients should be postponed for 4-7 weeks in order to optimize postoperative outcomes. Key words: COVID-19 surgery, morbidity, mortality