Comment on: Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): surgery may be the best treatment option

Dear Editor

We have read with great interest the paper published by Guadalajara and colleagues¹ about surgical treatment of inflammatory processes during the COVID-19 outbreak. They analysed 37 COVID-19-positive patients from a multicentre registry among 521 patients treated during the COVID-19 outbreak, compared with the same time frame in 2019 (822 patients). They concluded that COVID-19 status does not influence morbidity and mortality, and recommend surgical treatment for surgical inflammatory processes.

We would like to discuss some aspects of the study. First, these data should be interpreted carefully because a small population sample has been analysed. Although this is a multicentre study, only 37 COVID-19-positive patients were evaluated, so a large sample will be needed to be sure that these results are maintained because of their potentially severe clinical implications.

Second, the authors concluded that COVID-19 status does not influence morbidity but, in their data, patients with COVID-19 experienced higher complications and it seems that this cannot be attributed to the severity of the disease. It will be interesting to know what type of postoperative complications were experienced and whether more respiratory complications have been reported. Moreover, it will be helpful to know how many days after surgery complications were evaluated.

On the other hand, it should be noted that the confidence interval for COVID-19 status is very wide in the regression analysis. With a larger population, this interval would probably be narrower and the odds ratio of 2.62 would have more relevance.

Finally, we congratulate the authors as this type of paper is really necessary to improve evidence relating to surgical COVID-19-positive patients, because previous reports and international recommendations are based on poor-quality evidence. In this regard, some international registries for emergency surgical pathologies exist, such as the Cholecovid registry or the Spanish AEC-Covid-19 registry, which will help to improve evidence.

Disclosure. The authors declare no conflict of interest.