Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures.

Abstract

OBJECTIVE:

To evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery.

SUMMARY BACKGROUND DATA:

Although COVID-19 infection is usually associated with mild disease, it can lead to severe respiratory complications. Little is known about the perioperative outcomes of patients with COVID-19.

METHODS:

We examined patients who underwent urgent and emergent surgery at 2 hospitals in New York City from March 17 to April 15, 2020. Elective surgical procedures were cancelled throughout and routine, laboratory based COVID-19 screening was instituted on April 1. Mortality, complications, and admission to the intensive care unit were compared between patients with COVID-19 detected perioperatively and controls.

RESULTS:

Among 468 subjects, 36 (7.7%) had confirmed COVID-19. Among those with COVID-19, 55.6% were detected preoperatively and 44.4% postoperatively. Before the routine preoperative COVID-19 laboratory screening, 7.7% of cases were diagnosed preoperatively compared to 65.2% after institution of screening (P = 0.0008). The perioperative mortality rate was 16.7% in those with COVID-19 compared to 1.4% in COVID-19 negative subjects [aRR = 9.29; 95% confidence interval (CI), 5.68-15.21]. Serious complications were identified in 58.3% of COVID-19 subjects versus 6.0% of controls (aRR = 7.02; 95%CI, 4.96-9.92). Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were more common in those with COVID-19. The intensive care unit admission rate was 36.1% in those with COVID-19 compared to 16.4% of controls (aRR = 1.34; 95%CI, 0.86-2.09).

CONCLUSIONS:

COVID-19 is associated with an increased risk for serious perioperative morbidity and mortality. A substantial number of patients with COVID-19 are not identified until after surgery.

• Authors: Anne Knisely, Zhen Ni Zhou, Jenny Wu, Yongmei Huang, Kevin Holcomb, Alexander Melamed, Arnold P Advincula, Anil Lalwani, Fady Khoury-Collado, Ana I Tergas, Caryn M St Clair, June Y Hou, Dawn L Hershman, Mary E D'Alton, Yolanda Ya-Chin Huang, Jason D Wright
• Journal: Annals of surgery (Ann Surg) Vol. 273 Issue 1 Pg. 34-40 (01 01 2021) ISSN: 1528-1140 [Electronic] United States
• PMID: 33074900 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Adult
• Aged
• COVID-19 (epidemiology)
• Comorbidity
• Female
• Follow-Up Studies
• Humans
• Intensive Care Units (statistics & numerical data)
• Male
• Middle Aged
• Morbidity (trends)
• Postoperative Complications (epidemiology)
• Retrospective Studies
• SARS-CoV-2
• Surgical Procedures, Operative (adverse effects)
• Survival Rate (trends)
• United States (epidemiology)