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, 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
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 .
Keywords: Clavien-Dindo complications; Elective surgery; Emergent surgery; Mortality; SARS-CoV-2 (COVID19) pandemic.
Conflict of interest statement
The authors declare that they have no conflict of interest.
© 2021. The Author(s).
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Source: PubMed