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Outcomes and Their State-level Variation in Patients Undergoing Surgery With Perioperative SARS-CoV-2 Infection in the USA: A Prospective Multicenter Study.
Ann Surg ; 275(2): 247-251, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1522451
ABSTRACT

OBJECTIVE:

To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA.

BACKGROUND:

Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists.

METHODS:

As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality.

RESULTS:

A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]).

CONCLUSIONS:

Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Elective Surgical Procedures / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Ann Surg Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Elective Surgical Procedures / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Ann Surg Year: 2022 Document Type: Article