Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Knisely, Anne; Zhou, Zhen Ni; Wu, Jenny; Huang, Yongmei; Holcomb, Kevin; Melamed, Alexander; Advincula, Arnold P.; Lalwani, Anil; Khoury-Collado, Fady; Tergas, Ana I.; St. Clair, Caryn M.; Hou, June Y.; Hershman, Dawn L.; D'Alton, Mary E.; Huang, Yolanda Ya-Chin; Wright, Jason D.
• Is Part Of: Annals of surgery. Volume 273:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: COVID-19 -- infection -- pandemic -- SARS-CoV-2 -- surgery; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004420
• Languages: English
• ISSNs: 0003-4932

Abstract

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. Abstract : Supplemental Digital Content is available in the text