Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study

Abstract

Background: Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection. Methods and Material: We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model. Results: Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE ( P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively). Conclusions: SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.

Editorial: The impact of COVID-19 on immune system-related complications in surgical patients

“…This includes the release of a “cytokine storm” and activation of the complement system which promotes a systemic environment of hyperinflammation and hypercoagulability ( 8 – 15 ). These pathophysiological changes may contribute to the increased perioperative risk of thromboembolic complications and the high postoperative mortality observed in surgical patients with COVID-19 ( 16 – 20 ). The current special edition in Frontiers in Surgery was designed to improve the understanding of the immune-mediated pathophysiological events that lead to adverse outcomes in the vulnerable population of COVID-19 patients undergoing surgical procedures.…”

Biostatistics behind risk prediction models

“…The authors intend to share a few observations that they had while going through the risk prediction models research articles:[ 1 ]…”

Understanding respiratory disease 'due to' or 'with' COVID-19 to assess appropriate treatment

“…In this issue of the Journal of Postgraduate Medicine , the retrospective cohort study carried out by Karna et al . [ 17 ] is of interest because it investigates, albeit in a limited number of patients, the performance of prognostic risk scores and assesses the postoperative morbidity and mortality in COVID-19 patients after emergency surgery. The authors are to be commended for their research that, thanks to the type of inquiry they chose, offers us an opportunity for a thorough reappraisal of our understanding of the therapeutical approach to a specific disease in COVID-19 patients and its actual application in today's clinical practice.…”