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Multicenter Study
. 2021 Jan 1;273(1):34-40.
doi: 10.1097/SLA.0000000000004420.

Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures

Anne Knisely  1   2 , Zhen Ni Zhou  1   3   2 , Jenny Wu  1   2 , Yongmei Huang  1 , Kevin Holcomb  3   2 , Alexander Melamed  1   2 , Arnold P Advincula  1   2 , Anil Lalwani  1   2 , Fady Khoury-Collado  1   2 , Ana I Tergas  1   3   2 , Caryn M St Clair  1   2 , June Y Hou  1   2 , Dawn L Hershman  1   4 , Mary E D'Alton  1   2 , Yolanda Ya-Chin Huang  1   2 , Jason D Wright  1   2
Affiliations
Multicenter Study

Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures

Anne Knisely et al. Ann Surg. .

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.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

FIGURE 1
FIGURE 1
Total emergent and urgent surgical procedures from March 17 until April 15, 2020. Triangles represent COVID-19 patients diagnosed postoperatively, stars represent COVID-19 patients diagnosed preoperatively.
See this image and copyright information in PMC

Comment in

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