Venous thromboembolic complications as a predictor of mortality in patients with urgent abdominal surgical pathology and COVID-19
DOI:
https://doi.org/10.32782/2415-8127.2026.74.11Keywords:
coronavirus disease, emergency surgical interventions, venous thrombosis and embolism, mortalityAbstract
The COVID-19 pandemic has demonstrated a rapid increase in venous thromboembolic complications among patients operated on for acute abdominal surgical pathology, which consequently resulted in a significant rise in mortality. The risk of venous thrombosis in this cohort of patients remains underestimated to this day. Current recommendations of international surgical associations still lack sufficient evidence-based data regarding the prevention of venous thromboembolism in surgical patients. Objective. To investigate the structure of mortality among operated patients with acute abdominal surgical pathology and COVID-19, as well as to identify the main approaches for improving the effectiveness of prevention of venous thromboembolic complications. Materials and Methods. A retrospective analysis of 121 medical records and pathological autopsy reports of patients with urgent abdominal pathology and COVID-19 was performed. Surgical interventions were carried out in all patients; relaparotomy on demand was performed in 11.6% of cases, while planned relaparotomies were performed in 6.6%. The mean duration of surgery was 108.3 ± 24.5 minutes. Inclusion criteria were urgent abdominal surgical pathology, surgical intervention, and confirmed COVID-19. Exclusion criteria included age under 18 years and a negative polymerase chain reaction (PCR) test for SARS-CoV-2 RNA verification. The structure of postoperative mortality was as follows: surgery for acute intestinal obstruction was performed in 27 (22.3%) patients; acute calculous destructive cholecystitis in 24 (19.8%); strangulated ventral hernia in 18 (14.9%); perforated gastroduodenal ulcer in 14 (11.6%); acute perforated colonic diverticulitis in 11 (9.1%); acute pancreatic necrosis in 10 (8.3%); acute destructive appendicitis in 9 (7.4%); thoracoabdominal trauma in 6 (5.0%); and anterior abdominal wall phlegmon in 2 (1.7%) patients. Results and Discussion. Analysis of pathological and anatomical documentation demonstrated that venous thrombosis occurred significantly more frequently in patients with urgent abdominal surgical pathology combined with coronavirus disease. The overall incidence of thromboembolic complications in patients with COVID-19 reached 43.5%, while fatal pulmonary embolism accounted for 23.2% of deaths. In patients without COVID-19, the corresponding rates were lower, amounting to 36.2% and 16.1%, respectively. Evaluation of pathological examination findings confirmed that multimodal assessment of venous thrombosis risk factors substantiates the necessity for preventive antithrombotic measures.
Conclusions.
1. Venous thromboembolic complications remain one of the leading causes of postoperative mortality in patients with urgent abdominal surgical pathology and COVID-19.
2. The true incidence and risk of venous thromboembolism in operated patients during the COVID-19 pandemic remain underestimated.
3. In patients with acute abdominal surgical pathology and COVID-19, fatal pulmonary embolism was verified in 23.2% of cases, which significantly exceeded the corresponding rate among patients without coronavirus infection.
4. Current approaches to venous thromboembolism prevention require further improvement and adaptation for this category of patients.
References
Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J. Thromb. Haemostasis. 2020;18(7):1559–61. DOI 10.1111/jth.14849
Cuker A, Tseng EK, Nieuwlaat R, Angchaisuksiri P, Blair C, Dane K, et al. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv. 2021;5(3):872–88. DOI 10.1182/bloodadvances.2020003763
Матвійчук Б.О., Матвійчук О.Б., Федчишин Н.Р. Профілактика венозного тромбозу та тромбоемболії легеневої артерії у загальній хірургії: проблеми і перспективи. Клінічна хірургія. 2007;(8):36–38.
Abate, S.M., Mantefardo, B. & Basu, B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg 14, 37 (2020). doi:10.1186/s13037-020-00262-6.
De Simone B, Chouillard E, Sartelli M, Biffl WL, Di Saverio S, Moore EE, et al. The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper. World J Emerg Surg. 2021;16:14. doi:10.1186/s13017-021-00349-0.
Twine CP, Kakkos SK, Aboyans V, Baumgartner I, Behrendt CA, Bellmunt-Montoya S, et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. Eur J Vasc Endovasc Surg. 2023 May;65(5):627-689. doi:10.1016/j.ejvs.2023.03.042.
Sartelli M, Abu-Zidan FM, Labricciosa FM, et al. Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study. World J Emerg Surg. 2019 Jul 15;14:34.
Knight SR, Ho A, Pius R, Buchan I, Carson G, Drake TM, et al.; ISARIC4C investigators. Risk stratification of patients admitted to hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ. 2020;370:m3339.
Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, et al. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging. 2020;2(2):e200047. doi:10.1148/ryct.2020200047.
Prokop M, van Everdingen W, van Rees Vellinga T, van Ufford JQ, Stöger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19—Definition and Evaluation. Radiology. 2020;296(2):E97-E104. doi:10.1148/radiol.2020201473.
