Impact of the SARS-CoV-2 (COVID19) pandemic on the morbidity and mortality of high risk patients undergoing surgery: a non-inferiority retrospective observational study

Abstract

Background During the COVID-19 crisis it was necessary to generate a specific care network and reconvert operating rooms to attend emergency and high-acuity patients undergoing complex surgery. The aim of this study is to classify postoperative complications and mortality and to assess the impact that the COVID-19 pandemic may have had on the results. Methods this is a non-inferiority retrospective observational study. Two different groups of surgical patients were created: Pre-pandemic COVID and Pandemic COVID. Severity of illness was rated according to the Diagnosis-related Groups (DRG) score. Comparisons were made between groups and between DRG severity score-matched samples. Non-inferiority was set at up to 10 % difference for grade III to V complications according to the Clavien-Dindo classification, and up to 2 % difference in mortality. Results A total of 1649 patients in the PreCOVID group and 763 patients in the COVID group were analysed; 371 patients were matched for DRG severity score 3-4 (236 preCOVID and 135 COVID). No differences were found in relation to re-operation (22.5 % vs. 21.5 %) or late admission to critical care unit (5.1 % vs. 4.5 %). Clavien grade III to V complications occurred in 107 patients (45.3 %) in the PreCOVID group and in 56 patients (41.5 %) in the COVID group, and mortality was 12.7 % and 12.6 %, respectively. During the pandemic, 3 % of patients tested positive for Covid-19 on PCR: 12 patients undergoing elective surgery and 11 emergency surgery; there were 5 deaths, 3 of which were due to respiratory failure following Covid-19-induced pneumonia. Conclusions Although this study has some limitations, it has shown the non-inferiority of surgical outcomes during the COVID pandemic, and indicates that resuming elective surgery is safe. Trial registration Clinicaltrials.gov identifier: NCT04780594.

Impact of COVID-19 pandemic on surgical volume and outcomes in a terciary care center in Brazil

“…The present study demonstrated a 42% decrease in the volume of abdominal surgery of highrisk patients requiring ICU admission after the onset of COVID-19 pandemic without a major impact in surgical mortality. Our findings are consistent with several other authors, who demonstrated a decrease in the volume of several elective and emergency surgical procedures during the COVID-19 pandemic [23][24][25][29][30][31][32][33][34] ,without a significant increase in mortalityin most 31,[34][35][36][37] but not all reports 32,38,39 . Higher mortality rates in some reports were attributed to higher frequencies of emergent/urgent procedures in sicker patients 39 as well as lower availability of ICU beds during the initial waves of COVID-19 infection 40 .…”

Impacto da pandemia de COVID-19 no volume e resultados cirúrgicos em um centro de atendimento terciário no Brasil

“…O presente estudo demonstrou uma diminuição de 42% no volume de cirurgia abdominal de pacientes de alto risco que necessitaram de internação em UTI após o início da pandemia de COVID-19, sem grande impacto na mortalidade cirúrgica. Nossos achados são consistentes com os de vários outros autores, que demonstraram diminuição no volume de diversos procedimentos cirúrgicos eletivos e de emergência durante a pandemia de COVID-19 [23][24][25][29][30][31][32][33][34] ,sem aumento significativo da mortalidade na maioria 31,[34][35][36][37] ,mas não em todos 32,38,39 . As taxas de mortalidade mais elevadas em alguns relatórios foram atribuídas a frequências mais elevadas de procedimentos emergenciais em pacientes mais graves 39 , bem como à menor disponibilidade de leitos de UTI durante as ondas iniciais de infecção por COVID-19 40 .…”

Delivering Safe Surgical Care While Simultaneously Caring for Patients With COVID-19; Assessment of Patient Selection, Volume and Outcomes in a Tertiary Care Hospital

“…Even in the most complex interventions, there was no significant change in the CCI®, which is a very sensitive tool to determine overall morbidity. In Spain, non-inferior surgical outcomes during the COVID pandemic indicated that resuming elective surgery is safe even in high-risk patients ( 36 ). However, there were data, also from Spain, analyzing surgical outcomes in over 5,000 patients that saw a likelihood of greater failure-to-rescue than pre-pandemic controls ( 37 ).…”