Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 788-795
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.788
Surgical complications in COVID-19 patients in the setting of moderate to severe disease
Milena Gulinac, Ivan P Novakov, Svetozar Antovic, Tsvetelina Velikova
Milena Gulinac, Department of General and Clinical Pathology, Medical University, University Hospital "St George," Plovdiv 6000, Bulgaria
Ivan P Novakov, Department of Thoraco-abdominal Surgery, Medical University, Plovdiv 6000, Bulgaria
Svetozar Antovic, University Clinic for Digestive Surgery, Medical Faculty, Skopje 1000, Macedonia
Tsvetelina Velikova, Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Tsvetelina Velikova, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Author contributions: Gulinac M and Velikova T wrote the manuscript; All authors wrote additional sections of the paper; All authors revised and approved the final version of the manuscript; All authors take full responsibility for the integrity of all aspects of the work.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article selected by an in-house editor and fully peer-reviewed by external reviewers. Following the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works differently terms, provided the original work properly cited and the use is non-commercial. See:
Corresponding author: Tsvetelina Velikova, MD, PhD, Assistant Professor, Department of Clinical Immunology, University Hospital Lozenetz, Kozyak 1 Street, Sofia 1407, Bulgaria.
Received: February 7, 2021
Peer-review started: February 7, 2021
First decision: March 16, 2021
Revised: March 30, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: August 27, 2021

The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on the work of physicians and surgeons. The connection between the patient and the surgeon cannot be replaced by telemedicine. For example, the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic. The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care. Additionally, the adverse effects of any surgery delays and the financial consequences complicate the picture. Therefore, patients' admission during the COVID-19 pandemic should be taken into consideration, as well as preoperative measures. The COVID-19 situation brings particular risk to patients during surgery, where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients. This review discusses the recent factors associated with surgical complications, mortality rates, outcomes, and experience in COVID-19 surgical patients.

Keywords: COVID-19, SARS-CoV-2, Surgery, Surgery complications, Mortality rate, Acute respiratory distress syndrome, Thrombosis

Core Tip: The clinical outcomes of coronavirus disease 2019 (COVID-19) patients undergoing urgent or emergent surgeries have shown that the estimated duration of hospitalization is 10.55 d, with 15% admission in the intensive care unit and up to 15% in the postoperative period. Several complications are described in patients with COVID-19 who underwent surgical procedures, including acute respiratory distress syndrome and other pulmonary complications (e.g., pneumonia, shortness of breath, dyspnea, fever, cough). These complications lead to respiratory and cardiovascular system failure (i.e. heart attack, arrhythmia, and infarction), secondary infection, fatigue or myalgia, severe lymphopenia, sepsis/shock, acute kidney injury, etc. Pulmonary complications are considered the primary cause for the low survival rate and prolonged immobility in surgical COVID-19 patients. Lung involvement is also associated with high postoperative mortality, contributing to a 30-d mortality rate of 38%. Furthermore, cancer patients are more likely to contract COVID-19 than non-cancer patients. Therefore, they are more vulnerable to complications and have a higher mortality rate postoperatively. Thus, the impact of the COVID-19 pandemic on surgical patients in terms of delays or complications is noteworthy, and is expected to continue after the end of the pandemic.