## 3 Results
### Postoperative Outcomes in Pandemic and Non-Pandemic Groups
Furthermore, we assessed the differences in quality of care between the two study groups in terms of postoperative morbidity and in-hospital mortality. We found no significant differences in terms of hospital stay, wound related complications, Clostridium infection and acute cardiovascular complications, such as heart attack, malign arterial hypertension and acute pulmonary edema. However, we found an increased incidence of septic shock (\(p\) < 0.001) and death (\(p\) = 0.017) in the pandemic group. A multivariate analysis was carried out in order to identify the main factors related to the worse outcome among the study groups (namely pandemic group and non-pandemic group). We investigated as covariates age, sex, emergency presentation, bowel occlusion, the associated diseases and major postoperative complications. We used two logistic regression models: to compare pandemic/non- pandemic (Table 4); to compare death/non-death (Table 5). The logistic regression model found for bowel occlusion an odds ratio OR (pandemic/non-pandemic) = exp(1.542) = 4.673 with 95% confidence interval CI = (1.905, 11.466) and for the septic shock, an odds ratio OR (pandemic/non-pandemic) = exp(2.87) = 17.932 with 95% confidence interval CI = (5.001, 64.301). The frequency of bowel occlusion and septic shock were significantly higher in pandemic period (the significance of goodness of fit test of Hosmer and Lemeshow Test is \(p\) = 0.592). \begin{table}
\begin{tabular}{l c c c c c c c c} \hline \hline
**Independent** & \multirow{2}{*}{**B**} & \multirow{2}{*}{**S.E.**} & **Wald** & **df** & **Sig.** & \multirow{2}{*}{**OR (\({}^{\text{th}}\)) = Exp(B)**} & \multicolumn{2}{c}{**95\% C.I. for EXP(B)**} \\ \cline{3-3}
**Variable** & & & & & & **Lower** & **Upper** \\ \hline Bowel occlusion01 (\({}^{\text{a}}\)) & 1.542 & 0.458 & 11.334 & 1 & 0.001 & 4.673 & 1.905 & 11.466 \\ Septic shock01 (\({}^{\text{a}}\)) & 2.887 & 0.652 & 19.628 & 1 & 0.000 & 17.932 & 5.001 & 64.301 \\ Constant & \(-\)2.327 & 0.358 & 42.278 & 1 & 0.000 & 0.098 & & \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Logistic regression model for dependent variable pandemic/non-pandemic. \begin{table}
\begin{tabular}{l c c} \hline \hline
**Clavien Dindo Classification of Postoperative Complications** & \
\begin{tabular}{c} **Non-Pandemic Group** \\ **(No. of Cases, \%)** \\ \end{tabular} &
\begin{tabular}{c} **Pandemic Group** \\ **(No. of Cases, \%)** \\ \end{tabular} \\ \hline Grade I (SSI, minor complications treated pharmacologically) & 17 (14.4%) & 2 (11.1%) \\ \hline Grade II (treated pharmacologically) & 16 (13.5%) & 3 (16.6%) \\ \hline Grade III & 13 (11\%) & 4 (11.1%) \\ IIIA (reintervention without general anesthesia) & 4 (3.3%) & 0 \\ IIIB (reintervention with general anesthesia) & 9 (7.6%) & 4 (11.1%) \\ \hline Grade IV & 10 (8.4%) & 5 (13.8%) \\ IVA (requiring ICU) & 4 (3.3%) & 2 (5.5%) \\ IVB (with multiple organ failure) & 6 (5\%) & 3 (8.3%) \\ \hline Grade V & 8 (6.7%) & 9 (25\%) \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Postoperative morbidity in pandemic and non-pandemic groups according to the Clavien Dindo Classification of severity. In a multivariate analysis of the factors that were associated with fatal outcome, we found that higher age (OR: 1.266, CI: 1.115-1.438), a higher number of comorbidities (OR: 2.681, CI: 1.189-6.049), the septic shock (OR: 15.828; CI: 2.944-85.094) and diabetes for the patients in the pandemic group (OR: 40.271; CI: 2.044-793.365) increased the death risk. For this model, the significance of Hosmer and Lemeshow Test is \(p=0.606\). Interestingly, for the patients in the non-pandemic group, diabetes was not associated with increased risk for fatal outcome. This may reflect an increased vulnerability of diabetic patients during the COVID-19 pandemic. Septic shock was the most frequent cause of death in both groups, leading to a fatal outcome in 57.1% and 50% of cases with septic shock, respectively.