Objectives
The outcomes of emergency general surgery (EGS) patients with concomitant COVID-19 infection remain unknown. With a multicenter study in 361 hospitals from 52 countries, we sought to study the mortality and pulmonary complications of COVID-19 patients undergoing EGS.

Methods
All patients aged ≥17 years and diagnosed preoperatively with COVID-19 between February and July 2020 were included. EGS was defined as the urgent/emergent performance of appendectomy, cholecystectomy, or laparotomy. The main outcomes were 30-day mortality and 30-day pulmonary complications (a composite of acute respiratory distress syndrome, unexpected mechanical ventilation, pneumonia). Planned subgroup analyses were performed based on presence of preoperative COVID-related respiratory findings (e.g. cough, dyspnea, need for oxygen therapy, chest radiology abnormality).

Results
A total of 1,045 patients were included, of which 40.1% were female and 50.0% were older than 50 years; 461 (44.1%), 145 (13.9%), and 439 (42.0%) underwent appendectomy, cholecystectomy, and laparotomy, respectively. The overall mortality rate was 15.1% (158/1,045) and the overall pulmonary complication rate was 32.9% (344/1,045); in the subgroup of laparotomy patients, the rates were 30.6% (134/438) and 59.2% (260/439), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings.

Conclusion
COVID-19 patients undergoing EGS have significantly high rates of mortality and pulmonary complications, but the risk is most pronounced in those with preoperative respiratory findings.

Level of Evidence
Level III