BMC Anesthesiology (Nov 2021)

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,
  • Maria J. Colomina,
  • Leo A. Marin-Carcey,
  • Laura Viguera-Fernandez,
  • Roser Bayona-Domenge,
  • Sara Garcia-Ballester,
  • Albert López-Farre,
  • Leticia Ruiz-Buera,
  • Maite Sanz-Iturbe,
  • David Álvarez-Villegas,
  • Ely C. Jenssen-Paz,
  • Guillermo Puig-Sanz,
  • Aaron Arcos-Terrones,
  • Carmen Belmonte-Cuenca,
  • Elia Perelada-Alonso,
  • Francho Blasco-Blasco,
  • Antoni Sabaté

DOI
https://doi.org/10.1186/s12871-021-01495-3
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 10

Abstract

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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 .

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