Postoperative complications of patients during the COVID-19 pandemic.

Deng JZ, et al. The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States. Ann Surg. 2022 Feb 1;275(2): 242-246.

Results: Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients.

Conclusions: Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.

Haffner MR, et al. Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection. JAMA Netw Open. 2021 Apr 1;4(4):e215697.

Results: A total of 5470 surgical patients with positive COVID-19 test results were matched with 5470 surgical patients with negative COVID-19 test results during the same study period. Among all hospitals, there were more than double the number of deaths reported in the cohort of patients with COVID-19 (811 [14.8%]) compared with the cohort of patients without COVID-19 (388 [7.1%]) (P < .001). The rates of complications listed in the Vizient Clinical Data Base (818 [15.0%] vs 760 [13.9%]; P = .11) and median length of stay (10.0 [interquartile range (IQR), 1.3-36.4] vs 10.7 [IQR, 1.0-558.0] days; P = .86) did not differ significantly between the 2 groups. However, hospital-acquired conditions (110 [2.0%] vs 46 [0.8%]; P < .001) and patient safety indicators (183 [3.3%] vs 129 [2.4%]; P = .002) were higher in patients with COVID-19 (Table 1).

Knisely A, Zhou ZN, Wu J, et al. Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures. Ann Surg. 2021 Jan 1; 273(1):34-40.

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.

Ellison RT. Surgical complications in patients with COVID-19. NEJM Journal Watch, June 2, 2020.

“During the COVID-19 pandemic, most hospitals have suspended nonemergent surgeries. However, an increasing number of patients need urgent and semiurgent procedures, and there are economic incentives to restart elective surgery. Thus, it is critically important to know how COVID-19 affects surgical outcomes. An international observational study has assessed 30-day mortality and pulmonary complications in patients with COVID-19 undergoing surgery at 235 hospitals between January 1 and March 31, 2020. The infection was identified between 7 days before and 30 days after the procedure.

Among 1128 patients identified, 835 (74%) underwent emergency surgery, and 280, elective surgery. COVID-19 was diagnosed preoperatively in 294 (26%) and was confirmed by SARS-CoV-2 RNA detection in 969 (86%). The overall 30-day mortality rate was 24%; for elective procedures, 19%. Mortality was higher in men, patients over 70 years of age, ASA grades 3–5, malignancy, and with emergency and major surgical procedures. Pulmonary complications developed in 577 patients (51%) and were associated with a higher 30-day mortality rate.”

See also: American College of Surgeons (ACS). COVID-19 Resource Center: Clinical Issues and Guidance.

Created 08/21/20; updated 01/28/22.

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