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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

Author(s): Aishwarya Dutt, Ajay Bhandarwar, Girish Bakhshi, Nikhil Dhimole, Harshal Padekar, Snehal Dandge, Kaushal Lahoti, Advaith Chetan, Apoorva Raichur

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.

Journal Statistics

Impact Factor: * 3.1

CiteScore: 2.9

Acceptance Rate: 11.01%

Time to first decision: 10.4 days

Time from article received to acceptance: 2-3 weeks

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