Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
entrez:
23
3
2023
pubmed:
24
3
2023
medline:
25
3
2023
Statut:
ppublish
Résumé
Patients undergoing surgery with perioperative COVID-19 are suggested to have worse outcomes, but whether this is COVID-related or due to selection bias remains unclear. We aimed to compare the postoperative outcomes of patients with and without perioperative COVID-19. Patients with perioperative COVID-19 diagnosed within 7 days before or 30 days after surgery between February and July 2020 from 68 US hospitals in COVIDSurg, an international multicenter database, were 1:1 propensity score matched to patients without COVID-19 undergoing similar procedures in the 2012 American College of Surgeons National Surgical Quality Improvement Program database. The matching criteria included demographics (e.g., age, sex), comorbidities (e.g., diabetes, chronic obstructive pulmonary disease, chronic kidney disease), and operation characteristics (e.g., type, urgency, complexity). The primary outcome was 30-day hospital mortality. Secondary outcomes included hospital length of stay and 13 postoperative complications (e.g., pneumonia, renal failure, surgical site infection). A total of 97,936 patients were included, 1,054 with and 96,882 without COVID-19. Prematching, COVID-19 patients more often underwent emergency surgery (76.1% vs. 10.3%, p < 0.001). A total of 843 COVID-19 and 843 non-COVID-19 patients were successfully matched based on demographics, comorbidities, and operative characteristics. Postmatching, COVID-19 patients had a higher mortality (12.0% vs. 8.1%, p = 0.007), longer length of stay (6 [2-15] vs. 5 [1-12] days), and higher rates of acute renal failure (19.3% vs. 3.0%, p < 0.001), sepsis (13.5% vs. 9.0%, p = 0.003), and septic shock (11.8% vs. 6.0%, p < 0.001). They also had higher rates of thromboembolic complications such as deep vein thrombosis (4.4% vs. 1.5%, p < 0.001) and pulmonary embolism (2.5% vs. 0.4%, p < 0.001) but lower rates of bleeding (11.6% vs. 26.1%, p < 0.001). Patients undergoing surgery with perioperative COVID-19 have higher rates of 30-day mortality and postoperative complications, especially thromboembolic, compared with similar patients without COVID-19 undergoing similar surgeries. Such information is crucial for the complex surgical decision making and counseling of these patients. Prognostic and Epidemiologic; Level IV.
Sections du résumé
BACKGROUND
Patients undergoing surgery with perioperative COVID-19 are suggested to have worse outcomes, but whether this is COVID-related or due to selection bias remains unclear. We aimed to compare the postoperative outcomes of patients with and without perioperative COVID-19.
METHODS
Patients with perioperative COVID-19 diagnosed within 7 days before or 30 days after surgery between February and July 2020 from 68 US hospitals in COVIDSurg, an international multicenter database, were 1:1 propensity score matched to patients without COVID-19 undergoing similar procedures in the 2012 American College of Surgeons National Surgical Quality Improvement Program database. The matching criteria included demographics (e.g., age, sex), comorbidities (e.g., diabetes, chronic obstructive pulmonary disease, chronic kidney disease), and operation characteristics (e.g., type, urgency, complexity). The primary outcome was 30-day hospital mortality. Secondary outcomes included hospital length of stay and 13 postoperative complications (e.g., pneumonia, renal failure, surgical site infection).
RESULTS
A total of 97,936 patients were included, 1,054 with and 96,882 without COVID-19. Prematching, COVID-19 patients more often underwent emergency surgery (76.1% vs. 10.3%, p < 0.001). A total of 843 COVID-19 and 843 non-COVID-19 patients were successfully matched based on demographics, comorbidities, and operative characteristics. Postmatching, COVID-19 patients had a higher mortality (12.0% vs. 8.1%, p = 0.007), longer length of stay (6 [2-15] vs. 5 [1-12] days), and higher rates of acute renal failure (19.3% vs. 3.0%, p < 0.001), sepsis (13.5% vs. 9.0%, p = 0.003), and septic shock (11.8% vs. 6.0%, p < 0.001). They also had higher rates of thromboembolic complications such as deep vein thrombosis (4.4% vs. 1.5%, p < 0.001) and pulmonary embolism (2.5% vs. 0.4%, p < 0.001) but lower rates of bleeding (11.6% vs. 26.1%, p < 0.001).
CONCLUSION
Patients undergoing surgery with perioperative COVID-19 have higher rates of 30-day mortality and postoperative complications, especially thromboembolic, compared with similar patients without COVID-19 undergoing similar surgeries. Such information is crucial for the complex surgical decision making and counseling of these patients.
LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level IV.
Identifiants
pubmed: 36949053
doi: 10.1097/TA.0000000000003859
pii: 01586154-202304000-00003
pmc: PMC10044588
doi:
Types de publication
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
513-524Subventions
Organisme : Department of Health
Pays : United Kingdom
Investigateurs
Kwabena Siaw-Acheampong
(K)
Leah Argus
(L)
Daoud Chaudhry
(D)
Brett E Dawson
(BE)
James C Glasbey
(JC)
Rohan R Gujjuri
(RR)
Conor S Jones
(CS)
Sivesh K Kamarajah
(SK)
Chetan Khatri
(C)
James M Keatley
(JM)
Samuel Lawday
(S)
Elizabeth Li
(E)
Harvinder Mann
(H)
Ella J Marson
(EJ)
Kenneth A Mclean
(KA)
Maria Picciochi
(M)
Elliott H Taylor
(EH)
Abhinav Tiwari
(A)
Joana F F Simoes
(JFF)
Isobel M Trout
(IM)
Mary L Venn
(ML)
Richard J W Wilkin
(RJW)
Aneel Bhangu
(A)
Dmitri Nepogodiev
(D)
Irida Dajti
(I)
Arben Gjata
(A)
Luis Boccalatte
(L)
MariaMarta Modolo
(M)
Daniel Cox
(D)
Peter Pockney
(P)
Philip Townend
(P)
Felix Aigner
(F)
Irmgard Kronberger
(I)
Kamral Hossain
(K)
Gabrielle VanRamshorst
(G)
Ismail Lawani
(I)
Gustavo Ataide
(G)
Glauco Baiocchi
(G)
Igor Buarque
(I)
Muhammad Gohar
(M)
Mihail Slavchev
(M)
Arnav Agarwal
(A)
Amanpreet Brar
(A)
Janet Martin
(J)
Maria Marta Modolo
(MM)
Maricarmen Olivos
(M)
Jose Calvache
(J)
Carlos Jose Perez Rivera
(CJP)
Ana Danic Hadzibegovic
(AD)
Tomislav Kopjar
(T)
Jakov Mihanovic
(J)
Jaroslav Klat
(J)
René Novysedlak
(R)
Peter Christensen
(P)
Alaa El-Hussuna
(A)
Sylvia Batista
(S)
Eddy Lincango
(E)
Sameh H Emile
(SH)
Mengistu Gebreyohanes Mengesha
(MG)
Samuel Hailu
(S)
Hailu Tamiru
(H)
Joonas Kauppila
(J)
Johanna Laukkarinen
(J)
Alexis Arnaud
(A)
Markus Albertsmeiers
(M)
Hans Lederhuber
(H)
Markus Loffler
(M)
Stephen Tabiri
(S)
Symeon Metallidis
(S)
Georgios Tsoulfas
(G)
Maria Aguilera Lorena
(MA)
Gustavo Grecinos
(G)
Tamas Mersich
(T)
Daniel Wettstein
(D)
Dhruv Ghosh
(D)
Gabriele Kembuan
(G)
Peiman Brouk
(P)
Mohammad Khosravi
(M)
Masoud Mozafari
(M)
Ahmed Adil
(A)
Helen M Mohan
(HM)
Oded Zmora
(O)
Marco Fiore
(M)
Gaetano Gallo
(G)
Francesco Pata
(F)
Gianluca Pellino
(G)
Sohei Satoi
(S)
Faris Ayasra
(F)
Mohammad Chaar
(M)
Ildar R Fakhradiyev
(IR)
Mohammad Jamal
(M)
Muhammed Elhadi
(M)
Aiste Gulla
(A)
April Roslani
(A)
Laura Martinez
(L)
Antonio Ramos De La Medina
(AR)
Oumaima Outani
(O)
Pascal Jonker
(P)
Schelto Kruijff
(S)
Milou Noltes
(M)
Pieter Steinkamp
(P)
Willemijn van der Plas
(W)
Adesoji Ademuyiwa
(A)
Babatunde Osinaike
(B)
Justina Seyi-Olajide
(J)
Emmanuel Williams
(E)
Sofija Pejkova
(S)
Knut Magne Augestad
(KM)
Zainab Al Balushi
(Z)
Ahmad Qureshi
(A)
Raza Sayyed
(R)
Mustafa Abu Mohsen Daraghmeh
(MAM)
Sadi Abukhalaf
(S)
Moises Cukier
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Hugo Gomez
(H)
Sebastian Shu
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Ximena Vasquez
(X)
Marie Dione Parreno-Sacdalan
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(CM)
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(JNC)
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(N)
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(RB)
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(AM)
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(U)
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William Jebril
(W)
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(TD)
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(JP)
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(C)
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(MD)
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(A)
Elaine Leung
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Lisa Norman
(L)
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(EM)
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(N)
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(C)
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F T Drake
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A Goldenberg-Sandau
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R Grolman
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T Liu
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Informations de copyright
Copyright © 2023 American Association for the Surgery of Trauma.
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