Emergency abdominal surgical operative findings in patients infected with the COVID-19 virus in Kirkuk governorate during the period 2020-2021

Abstract

Objective: To assess the effect of COVID-19 infection on laboratory results, intraoperative surgical outcomes, and preoperative clinical characteristics, and to ascertain if COVID-19 status is associated with increased disease burden, physiological disturbances, and surgical complexity in patients undergoing emergency abdominal surgery.

Methods: This retrospective case-control study was performed at Azadi Teaching Hospital, Kirkuk, Iraq, between March 1, 2020, and September 1, 2021. A total of 350 patients who underwent emergency surgery were included: 146 COVID-19-positive patients and 204 COVID-19-negative patients. COVID-19 diagnosis was made via CT scan and detection of IgM and IgG antibodies. Serological and biochemical markers measured included C-reactive protein, lymphocyte percentage, urea, and creatinine. The main outcomes were postoperative complications, hospital stay, and mortality.

Results: Significantly higher CRP levels (15.2 ± 7.8 mg/L) were seen in COVID-19-positive patients versus controls (6.48 ± 3.05 mg/L; p < 0.0001), along with lower lymphocyte percentages (21.4 ± 5.66% vs 35.95 ± 4.05%; p < 0.0001) and elevated renal function parameters. Higher postoperative complications occurred in COVID-19-positive patients (43.2% vs 26.0%; p = 0.001), with longer hospital stay (19.5 ± 5.65 days vs 8.10 ± 3.66 days; p < 0.0001). Mortality was not significantly different (4.8% vs 2.0%; p = 0.212). Surgical conditions differed notably: mesenteric ischemia (39.04% vs 5.88%) and retroperitoneal bleeding (34.93% vs 6.86%).

Conclusions: COVID-19 in emergency abdominal surgery patients was associated with increased clinical severity, postoperative complications, and hospitalisation. Mortality was not significantly different, suggesting patients can safely undergo emergency surgery despite COVID-19.