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Observational Study
. 2021 Nov 26;21(1):295.
doi: 10.1186/s12871-021-01495-3.

Impact of the SARS-CoV-2 (COVID19) pandemic on the morbidity and mortality of high risk patients undergoing surgery: a non-inferiority retrospective observational study

Marta Caballero-Milán  1   2   3 , Maria J Colomina  4   5   6 , Leo A Marin-Carcey  4 , Laura Viguera-Fernandez  4 , Roser Bayona-Domenge  4 , Sara Garcia-Ballester  4 , Albert López-Farre  4 , Leticia Ruiz-Buera  4 , Maite Sanz-Iturbe  4 , David Álvarez-Villegas  4 , Ely C Jenssen-Paz  4 , Guillermo Puig-Sanz  4 , Aaron Arcos-Terrones  4 , Carmen Belmonte-Cuenca  4 , Elia Perelada-Alonso  4 , Francho Blasco-Blasco  4 , Antoni Sabaté  4
Affiliations
Observational Study

Impact of the SARS-CoV-2 (COVID19) pandemic on the morbidity and mortality of high risk patients undergoing surgery: a non-inferiority retrospective observational study

Marta Caballero-Milán et al. BMC Anesthesiol. .

Abstract

Background: During the COVID-19 crisis it was necessary to generate a specific care network and reconvert operating rooms to attend emergency and high-acuity patients undergoing complex surgery. The aim of this study is to classify postoperative complications and mortality and to assess the impact that the COVID-19 pandemic may have had on the results.

Methods: this is a non-inferiority retrospective observational study. Two different groups of surgical patients were created: Pre-pandemic COVID and Pandemic COVID. Severity of illness was rated according to the Diagnosis-related Groups (DRG) score. Comparisons were made between groups and between DRG severity score-matched samples. Non-inferiority was set at up to 10 % difference for grade III to V complications according to the Clavien-Dindo classification, and up to 2 % difference in mortality.

Results: A total of 1649 patients in the PreCOVID group and 763 patients in the COVID group were analysed; 371 patients were matched for DRG severity score 3-4 (236 preCOVID and 135 COVID). No differences were found in relation to re-operation (22.5 % vs. 21.5 %) or late admission to critical care unit (5.1 % vs. 4.5 %). Clavien grade III to V complications occurred in 107 patients (45.3 %) in the PreCOVID group and in 56 patients (41.5 %) in the COVID group, and mortality was 12.7 % and 12.6 %, respectively. During the pandemic, 3 % of patients tested positive for Covid-19 on PCR: 12 patients undergoing elective surgery and 11 emergency surgery; there were 5 deaths, 3 of which were due to respiratory failure following Covid-19-induced pneumonia.

Conclusions: Although this study has some limitations, it has shown the non-inferiority of surgical outcomes during the COVID pandemic, and indicates that resuming elective surgery is safe.

Trial registration: Clinicaltrials.gov identifier: NCT04780594 .

Keywords: Clavien-Dindo complications; Elective surgery; Emergent surgery; Mortality; SARS-CoV-2 (COVID19) pandemic.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

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