Risk Factors Associated With Postoperative Mortality Among COVID-19 Positive Patients: Results of 3027 Operations and Procedures

Abstract

Objective: To investigate the predictors of postoperative mortality in coronavirus disease 2019 (COVID-19)-positive patients. Background: COVID-19-positive patients have more postoperative complications. Studies investigating the risk factors for postoperative mortality in COVID-19-positive patients are limited. Methods: COVID-19-positive patients who underwent surgeries/procedures in Cleveland Clinic between January 2020 and March 2021 were identified retrospectively. The primary outcome was postoperative/procedural 30-day mortality. Secondary outcomes were length of stay, intensive care unit admission, and 30-day readmission. Results: A total of 2543 patients who underwent 3027 surgeries/procedures were included. Total 48.5% of the patients were male. The mean age was 57.8 (18.3) years. A total of 71.2% had at least 1 comorbidity. Total 78.7% of the cases were elective. The median operative time was 94 (47.0-162) minutes and mean length of stay was 6.43 (13.4) days. Postoperative/procedural mortality rate was 4.01%. Increased age [odds ratio (OR): 1.66, 95% CI, 1.4-1.98; P < 0.001], being a current smoker [2.76, (1.3-5.82); P = 0.008], presence of comorbidity [3.22, (1.03-10.03); P = 0.043], emergency [6.35, (3.39-11.89); P < 0.001] and urgent versus [1.78, (1.12-2.84); P = 0.015] elective surgery, admission through the emergency department [15.97, (2.00-127.31); P = 0.009], or inpatient service [32.28, (7.75-134.46); P < 0.001] versus outpatients were associated with mortality in the multivariable analysis. Among all specialties, thoracic surgery [3.76, (1.66-8.53); P = 0.002] had the highest association with mortality. Total 17.5% of the patients required intensive care unit admission with increased body mass index being a predictor [1.03, (1.01-1.05); P = 0.005]. Conclusions: COVID-19-positive patients have higher risk of postintervention mortality. Risk factors should be carefully evaluated before intervention. Further studies are needed to understand the impact of pandemic on long-term surgical/procedural outcomes.

Postoperative Outcomes After Emergency Surgery in COVID-19 Patients: An Ambispective Matched Cohort Study

“…It may not be possible to defer emergency or urgent surgery for this suggested period. Recent studies have also observed an increased risk of mortality after emergency surgery [HR 6.35, (3.39,11.89), p-value < 0.001] in COVID-19 patients as compared to elective surgery [ 16 ].…”

Timing of Surgery in Patients with Novel Coronavirus Infection: Basing on Current Epidemiological Characteristics and The Impact on Physiological Functions

“…Non-surgical or conservative treatment of emergency patients should be considered first, wherever feasible and safe. As the risk of death at 30 days postoperatively is 6.35 times higher for emergency surgery than for elective surgery in patients with a positive COVID-19 infection, [10] non-surgical management of patients with a positive COVID-19 infection is strongly recommended. Assessment of emergency patients should not be delayed in order to determine novel coronavirus infection status, and it is recommended that involved healthcare workers should strictly wear personal protective equipment.…”

“…The risk is highest for cardiothoracic surgery, with the risk of death at 30 days postoperatively being 2.01 times higher than gastrointestinal surgery. [10] Therefore, the cardiopulmonary function should be carefully assessed preoperatively for patients undergoing elective cardiothoracic surgery. In a study of children undergoing surgery for congenital heart disease, no difference was found in the incidence of postoperative complications between COVID-19 positive children who underwent surgery 6 weeks after recovery and COVID-19 negative children.…”

Impact of COVID-19 Pandemic Surge on Surgical Outcomes: A Retrospective Study

“…5-9 Among patients infected with COVID-19 and undergoing surgery, the risk factors for postoperative complications include the time to surgery after COVID-19 infection, 10 vaccination status, 11 comorbidities, 12 male sex, 13 and advancing age. 12 The SARS-CoV-2 virus can cause endothelial damage and immunosuppression, resulting in a higher incidence of postoperative thromboembolism and infectious complications. 10,14…”