ABSTRACT
SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle