Impact of SARS-CoV-2 infection on perioperative mortality

Abstract

Introduction: perioperatively acquired COVID-19 may increase mortality. The aim of this study was to assess the influence of SARS-CoV-2 infection on the length of stay and mortality among surgical patients.

Methods: retrospective study of surgical interventions performed between 1st March 2020 and 31st December 2022 after exclusion of minor procedures. Clinical, administrative, and epidemiological data were collected. Multivariate Cox regression analysis was conducted.

Results: 19,152 interventions were included. Patients had median age of 66 years (53-77), 53.8% were male, and the median number of conditions was 1 (0-3). Six hundred and twenty-two (3.2%) interventions were performed in COVID-19 patients, who were older (70 (57-80) vs 67 (55-77) years; p = 0.003) and more comorbid (2 (1-3) vs 1 (0-3); p < 0.001). COVID-19 patients had longer stays (11 (4-28) vs 6 (3-12) days; p < 0.001), and higher mortality rates (incidence rate ratio 2.28 (1.70-3.00), p < 0.001). The adjusted hazard ratio was 1.54 (1.15-2.05), p = 0.001. Age, number of conditions, and incomplete vaccination, and surgeries conducted in 2022 (as compared to 2020 and 2021) were related to higher mortality. Mortality was higher during the first week of the infection, but not after that (HR 2.09 (1.04-4.21), p = 0.037), and the risk window narrowed after 2020.

Conclusions: perioperative COVID-19 increases mortality, especially during the first week of the infection. Age, comorbidity, and vaccine status should also be considered when scheduling interventions.

Keywords: COVID-19; Mortalidad perioperatoria; Periodo perioperatorio; Perioperative mortality; Perioperative period; SARS-CoV-2.