Morbidity and Mortality in Patients with Perioperative COVID‐19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery

Abstract

Background Severe acute respiratory syndrome due to coronavirus 2 has rapidly spread worldwide in an unprecedented pandemic. Patients with an ongoing COVID-19 infection requiring surgery have higher risk of mortality and complications. This study describes the mortality and morbidity in patients with perioperative COVID-19 infection undergoing elective and emergency surgeries. Methods Prospective cohort of consecutive patients who required a general, gastroesophageal, hepatobiliary, colorectal, or emergency surgery during COVID-19 pandemic at an academic teaching hospital. The primary outcome was 30-day mortality and major complications. Secondary outcomes were specific respiratory mortality and complications. Results A total of 701 patients underwent surgery, 39 (5.6%) with a perioperative COVID-19 infection. 30-day mortality was 12.8% and 1.4% in patients with and without COVID-19 infection, respectively (p \ 0.001). Major surgical complications occurred in 25.6% and 6.8% in patients with and without COVID-19 infection, respectively (p \ 0.001). Respiratory complications occurred in 30.8% and 1.4% in patients with and without COVID-19 infection, respectively (p \ 0.001). Mortality due to a respiratory complication was 100% and 11.1% in patients with and without COVID-19 infection, respectively (p \ 0.006). Conclusions 30-day mortality and surgical complications are higher in patients with perioperative COVID-19 infection. Indications for elective surgery need to be reserved for non-deferrable procedures in order to avoid unnecessary risks of non-urgent procedures.

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

“…Perioperative COVID-19 infection has negatively impacted the safety of patients undergoing surgery, increasing complications and mortality rates [ 1 , 4 ]. Currently, only a few studies have reported data on the risk of perioperative COVID-19 infection and safety outcomes in patients undergoing bariatric surgery during the ongoing pandemic [ 13 – 15 , 20 ].…”

“…Also, it is important to consider that the opening phase for bariatric surgery occurred when SARS-CoV-2 viral circulation levels were low; thus, we cannot extrapolate these results when circulating viral levels are higher. A strength of our study is that we have a 100% follow-up of all our 189 patients during the first 30 days after discharge, and we were able to use the same rigorous COVID-19 protocol and recommendations that we used in the early phases of the pandemic for unpostponable surgeries, with positive results [ 4 ].…”

“…Postoperative COVID-19 infection was defined in all patients with SARS-CoV-2 symptoms that tested positive during the 30-day follow-up. Institutional protocols were adopted to care for patients from arrival to the preoperative, ward, and postoperative recovery [ 4 ]. During the 30-day follow-up, PCR tests were indicated if the patient developed fever or respiratory symptoms.…”

“…Moreover, early reports also showed unexpected high mortality due to COVID-19-associated complications in a set of patients undergoing general surgery procedures and bariatric surgery early at the beginning of the pandemic [ 2 , 3 ]. Our group reported our perioperative results in a cohort of 701 consecutive patients who underwent unpostponable oncological and emergency surgeries and found that patients with perioperative COVID-19 infection had a higher 30-day rate of overall complications, COVID-19-associated complications, and mortality [ 4 ]. We observed a 30-day mortality rate of 12.8% in patients with COVID-19 infection and 1.4% in patients without infection, which is lower than the 23.8% mortality reported in the most extensive study published today [ 1 ].…”

COVID-19 as a concomitant diagnosis and the emergencies behind COVID-19 mask – a real challenge that requires a multidisciplinary view of the patient

“…30-day mortality and surgical complications are more common in patients with concomitant COVID-19 infection -in a total of 701 patients undergoing surgical treatment, 39 /5.6%/ of whom with perioperative CO-VID-19 infection, 30-day mortality was 12.8% and 1.4% in patients without COVID-19 infection, respectively (p < 0.001). It is appropriate in COVID-19 patients to perform only emergency surgical interventions in view of the increased risk of irreversible complications (Inzunza et al 2020). Patients who underwent surgery had a higher mortality rate if they were diagnosed with COVID-19 after surgery, than if they were diagnosed with COVID-19 before.…”