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Observational Study
. 2021 Dec 1;274(6):904-912.
doi: 10.1097/SLA.0000000000005152.

Impact of the COVID-19 Pandemic on Emergency Adult Surgical Patients and Surgical Services: An International Multi-center Cohort Study and Department Survey

Jasmine Winter Beatty  1   2 , Jonathan M Clarke  3 , Viknesh Sounderajah  1   2   4 , Amish Acharya  1   2   4 , Simon Rabinowicz  1 , Guy Martin  1   2 , Leigh R Warren  1   4 , Seema Yalamanchili  1   2   4 , Alasdair J Scott  1   2   4 , Elizabeth Burgnon  1 , Sanjay Purkayastha  1   2 , Sheraz Markar  1   2 , James M Kinross  1   2 ; on behalf of the PANSURG-PREDICT Collaborative
Collaborators, Affiliations
Observational Study

Impact of the COVID-19 Pandemic on Emergency Adult Surgical Patients and Surgical Services: An International Multi-center Cohort Study and Department Survey

Jasmine Winter Beatty et al. Ann Surg. .

Abstract

Objectives: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort.

Background: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified.

Methods: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented.

Results: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18.87), ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing.

Conclusion: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.

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Conflict of interest statement

The authors report no conflicts of interest to declare.

References

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