Abstract
Objective: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA.
Background: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists.
Methods: As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality.
Results: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65–3.69]), male sex (2.26 [1.53–3.35]), ASA grades 3–5 (3.08 [1.60–5.95]), emergent surgery (2.44 [1.31–4.54]), malignancy (2.97 [1.58–5.57]), respiratory comorbidities (2.08 [1.30–3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02–1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03–0.61]).
Conclusions: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.
Background: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists.
Methods: As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality.
Results: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65–3.69]), male sex (2.26 [1.53–3.35]), ASA grades 3–5 (3.08 [1.60–5.95]), emergent surgery (2.44 [1.31–4.54]), malignancy (2.97 [1.58–5.57]), respiratory comorbidities (2.08 [1.30–3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02–1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03–0.61]).
Conclusions: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.
| Original language | English |
|---|---|
| Pages (from-to) | 247-251 |
| Number of pages | 5 |
| Journal | Annals of surgery |
| Volume | 275 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 28 Feb 2022 |
Bibliographical note
Funding:This study was funded by the National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. The funding bodies have no rule design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Keywords
- COVID-19
- COVIDSurg
- elective surgery
- emergency surgery
- mortality
- pulmonary complications