Explorations Gone Viral: A Comparative Study of Emergency Laparotomies in COVID-19 Positive vs COVID-19 Negative Patients at A Tertiary Care Hospital during the COVID-19 Pandemic
{"title":"Explorations Gone Viral: A Comparative Study of Emergency Laparotomies in COVID-19 Positive vs COVID-19 Negative Patients at A Tertiary Care Hospital during the COVID-19 Pandemic","authors":"Aishwarya Dutt, Ajay Bhandarwar, Girish Bakhshi, Nikhil Dhimole, Harshal Padekar, Snehal Dandge, Kaushal Lahoti, Advaith Chetan, Apoorva Raichur","doi":"10.26502/acbr.50170366","DOIUrl":null,"url":null,"abstract":"Aim: To compare the mortality in emergency laparotomy cases between those with COVID-19 infection to those without the infection and to identify predicting factors that would help in optimum management for the same. Method: A prospective observational study was conducted in a tertiary care centre in Mumbai. Patients underwent exploratory laparotomy of which 20 were COVID-19 positive (Group A) while 20 were COVID-19 negative (Group B). Patient’s details with blood investigations, radiological investigations, preoperative and postoperative stay were taken into consideration. All these parameters were studied and compared in detail. Result: 40 cases that underwent emergency laparotomy for various causes were compared. Pulmonary complications were seen postoperatively in 45% patients of Group A and 15% patients of Group B. Mortality was seen in 40% cases of Group A of which 87.5% cases were due to postoperative respiratory complications due to COVID-19 infection. Group B had one mortality, due to septic shock. Mortality was significantly higher in Group A(p-value: 0.008). Comorbidities such as hypertension, diabetes mellitus and ischemic heart disease were seen to be associated with a higher incidence of mortality. Mortality was witnessed more in the age group above 40 years. High APACHE-II score and Computed Tomography severity index (CTSI) showed higher mortality. Antivirals did not show any effect on postoperative survival. Conclusion: Emergency operations can be taken up in COVID-19 positive patients with adequate precautions. Postoperative complications are related to comorbidities, age and CTSI. High index of suspicion for pulmonary complications and aggressive postoperative management with steroids gives improved outcomes.","PeriodicalId":72279,"journal":{"name":"Archives of clinical and biomedical research","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of clinical and biomedical research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.26502/acbr.50170366","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Aim: To compare the mortality in emergency laparotomy cases between those with COVID-19 infection to those without the infection and to identify predicting factors that would help in optimum management for the same. Method: A prospective observational study was conducted in a tertiary care centre in Mumbai. Patients underwent exploratory laparotomy of which 20 were COVID-19 positive (Group A) while 20 were COVID-19 negative (Group B). Patient’s details with blood investigations, radiological investigations, preoperative and postoperative stay were taken into consideration. All these parameters were studied and compared in detail. Result: 40 cases that underwent emergency laparotomy for various causes were compared. Pulmonary complications were seen postoperatively in 45% patients of Group A and 15% patients of Group B. Mortality was seen in 40% cases of Group A of which 87.5% cases were due to postoperative respiratory complications due to COVID-19 infection. Group B had one mortality, due to septic shock. Mortality was significantly higher in Group A(p-value: 0.008). Comorbidities such as hypertension, diabetes mellitus and ischemic heart disease were seen to be associated with a higher incidence of mortality. Mortality was witnessed more in the age group above 40 years. High APACHE-II score and Computed Tomography severity index (CTSI) showed higher mortality. Antivirals did not show any effect on postoperative survival. Conclusion: Emergency operations can be taken up in COVID-19 positive patients with adequate precautions. Postoperative complications are related to comorbidities, age and CTSI. High index of suspicion for pulmonary complications and aggressive postoperative management with steroids gives improved outcomes.