Postoperative Outcomes in Surgical COVID-19 Patients

A Multicenter Cohort Study

François Martin Carrier; Éva Amzallag; Vincent Lecluyse; Geneviève Côté; Étienne J. Couture; Frédérick D'Aragon; Stanislas Kandelman; Alexis F. Turgeon; Alain Deschamps; Roy Nitulescu; Codjo Djignefa Djade; Martin Girard; Pierre Beaulieu; Philippe Richebé


BMC Anesthesiol. 2021;21(15) 

In This Article


The world is experiencing a pandemic on a scale that has not been seen for many decades. Estimates of COVID-19 (Coronavirus Disease 2019) case fatalities are variable and have been reported to be between less than 1 and 7%.[1–4] Although resource utilization, such as hospitalization, and intensive care unit (ICU) admission, is well documented in COVID-19 patients, data on their surgical needs and outcomes remains limited.[1–8]

Viral pneumonia is mostly a medical condition, but infected patients may require surgery.[7–10] To provide anesthetic and surgical care to COVID-19 patients, healthcare workers have to reorganize surgical platforms, personal protective equipment protocols, and in-hospital patient trajectories to prevent a viral spread to healthcare workers and other patients.[11–15] Documenting the needs for, and variety of, surgical procedures in this population is paramount in order to estimate the accrued risk for the patients.

Postoperative outcomes in SARS-CoV-2 infected patients have been previously reported.[7,8,16] Recently published data suggest an overall postoperative 30-day mortality between 19 and 24%, with more than half of the patients having postoperative pulmonary complications. These studies, mostly from Europe and the Middle East, did not report the overall impact of the pandemic on surgical activity. The surgical needs and postoperative outcomes of COVID-19 patients, as well as the overall access to surgical care during such a pandemic have yet to be fully evaluated in a Canadian setting.

To address this, we conducted a multicenter observational cohort study in the Province of Québec, the Canadian province most afflicted by the pandemic.[17] Our primary objective was to describe the perioperative characteristics of patients infected by SARS-CoV-2 who underwent surgery and their postoperative outcomes. Our secondary objectives were to explore the effect of the presence of symptoms on outcomes, describe the impact of the SARS-CoV-2 pandemic on overall surgical care and describe the characteristics and outcomes of suspected COVID-19 patients and those who had recovered from COVID-19 and underwent surgery during the same observation period. We hypothesized that the number of COVID-19 surgical patients would be small with a higher mortality among those with symptoms, that the impact of the pandemic on surgical care would be notable and that postoperative outcomes would be comparable between COVID-19 and suspected patients.