In December 2019, the outbreak of COVID-19 (new type of coronavirus, 2019-nCoV) caused by the coronavirus SARS 2 (SARS-CoV-2) occurred in Wuhan, China (1-3). On January 31^st, 2020, the World Health Organization (WHO) declared the pandemic as a world health emergency (4). The most common manifestations of COVID-19 include fever, dry cough, shortness of breath, fatigue, and chest radiographic evidence (5, 6). Despite recent evidence of known clinical respiratory manifestations, sometimes the disease is manifested by unusual symptoms in the gastrointestinal tract, heart, skin, and central nervous system, which can cause several complications, including acute respiratory distress syndrome [ARDS], arrhythmia, shock, acute heart injury, secondary infection, acute kidney injury, and in severe cases death (7).
Rapid identification and isolation of cases, quarantine of close contacts, and active monitoring of other communications have effectively suppressed the outbreak's expansion and have implications for other countries experiencing outbreaks (8, 9).
The World Health Organization's status report shows that the United States ranks first with the highest number of cases, hospitalizations, and deaths, and the European region ranks second (10). It is estimated that the number may even be much more than the reported figures in some areas. The challenge of COVID-19 has been proven worldwide due to its lack of proven treatment and the complexity of its transmission. All health services worldwide have made significant changes to their management rules to address the challenges posed by COVID-19. These changes aim to reduce the prevalence and complications of the disease and reduce contact to minimize disease transmission (11).
Epidemiological studies have shown that in patients with underlying diseases (including asthma, tuberculosis, diabetes mellitus, hypertension, kidney disease, liver disease, and heart disease), smoking and substance use history, male gender and age older than 60 years, the probability of death or adverse consequences is more common (12). Surgery during the virus outbreak was challenging for patients with COVID-19, health care workers, and non-COVID-19 patients (13). The outcome of patients with coronavirus infection who have undergone surgery is highly variable. Some studies have shown that postoperative mortality and complications are very high in patients with COVID-19 (14).
However, some studies have not been able to identify significant complications among patients with COVID-19 who have undergone surgery (1, 15-23). Health systems addressed two major issues with this pandemic in surgery. First, to postpone many non-emergency surgical procedures to reduce the burden on the system, which can slow transmission, reduce potential surgical complications in patients, and conserve resources, including health professionals, medications, beds, and ventilators. Second, to perform intensive care and follow-up in patients requiring emergency surgery. This has led to a significant reduction in the burden of surgical procedures (16).
In the obstetrics and gynecology ward, surgeries were divided into three categories: emergency, semi-emergency, and non-emergency (17). Emergency surgery is a surgery in which the existing conditions pose an acute threat to life, and surgery must be performed without delay (such as an emergency cesarean section). Semi-emergency conditions are the ones that, although not immediately life-threatening, if they are delayed, can cause severe pain or dysfunction or more damage (like most oncology surgeries) that surgery should not be delayed. Non-emergency surgery is planned for conditions unlikely to cause dysfunction or injury (such as reconstructive surgery).
In the obstetrics wards, as in other ones, patients with COVID-19 sometimes require emergency surgery. Also, studies have shown that a small number of asymptomatic patients during the latent period have undergone surgery. The actual effect of postoperative outcomes in patients with COVID-19 remains unknown. A 2020 study by David Phelps et al., which reviewed 14 related articles on surgical outcome in patients with COVID-19, concluded that possible risk factors were associated with an increased risk of mortality included males, age 70 years, and underlying comorbidities. But in these studies, the possibility of increased complications and mortality after surgery was not seen in patients with COVID-19 (18).
Due to the high prevalence of the disease, the need for surgery, and insufficient information about the complications of surgery in these patients, this study aimed to investigate the outcome of surgeries in patients with COVID-19 in the obstetrics ward, Motahhari Hospital in Urmia from March 2020 to March 2021.

 

This cross-sectional study was performed after obtaining approval from the University Medical Ethics Committee (with ethics ID IR.UMSU.REC.1399.327) from March 2020 to March 2021 in Motahhari Hospital in the gynecology and obstetrics department have undergone surgery. The study was done on all patients who had a COVID-19 nasopharyngeal swab laboratory test, and a positive PCR test, or clinical manifestations and laboratory signs and positive imaging in favor of COVID-19 and have been approved by an infectious and internal medicine specialist.
A total of 112 patients were included in the study. From the records of these patients in a completely confidential manner and in accordance with the principle of patient confidentiality (and if necessary by a phone conversation), a checklist that included the following information was extracted and recorded : demographic information (such as age, level of education, economic level, occupation, and marital status), medical history background (such as blood pressure, diabetes, lung problems, heart disease and kidney disease), history of medication use and type of medication used, history of hospitalization or death of a family member due to COVID-19, the cause of hospitalization and early symptoms at the time of arrival to the hospital, cause of surgery (type of surgery, emergency or non-emergency), duration of surgery, type of anesthesia, clinical condition of the patient after surgery (such as vital signs, blood oxygen level, exacerbation of symptoms and course of the disease) , laboratory data (such as CBC-LDH-CRP) before and after surgery, assessment of oxygen demand and the need for endotracheal intubation, initiation of drug treatment and type of treatment and duration of drug administration, duration of hospitalization and the need for hospitalization in the intensive care unit, and any complications related to surgery up to one month after surgery.
Data analysis was performed using SPSS software version 22, and descriptive statistics, nonparametric statistical analysis, and descriptive statistics were used to summarize the data. Nonparametric tests such as Mann-Whitney and Spearman correlation coefficients were used. The significance level was considered as p = 0.05.