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

Disclosures

BMC Anesthesiol. 2021;21(15) 

In This Article

Results

Baseline and surgical characteristics are reported in Table 1 for COVID-19 patients and in Table S2 for other patients, while surgical specialties are reported in Table S1 for all included patients.

COVID-19 Patients

Forty-four patients (42 with a preoperative positive PCR test) with COVID-19 underwent a surgical procedure between March 13, 2020, and June 19, 2020. Among these 44 patients with COVID-19, 26 patients were symptomatic at time of surgery with 18 being asymptomatic carriers. Demographics and surgical characteristics were similar between these groups, except for preoperative treatments and respiratory support (Table 1). In these patients, 71% of surgeries were urgent, 36% were major ones and 64% were performed under general anesthesia; these characteristics seemed to be similar between symptomatic and asymptomatic patients (Table 1). Complications were relatively rare, with the exception of pulmonary complications (25%) and new ICU admissions (27%). These complications seemed to be higher in symptomatic COVID-19 patients (Table 2). The overall 30-day mortality was 15.9% in these patients (Table 2). This mortality was numerically higher in symptomatic patients (23.1% in symptomatic patients and 5.6% in asymptomatic patients), although the observed difference between strata was not significant (P = 0.12) (Table 2 and Figure 1). As a sensitivity analysis, we excluded six COVID-19 patients who had a tracheotomy as a surgical procedure. In this subgroup of 38 patients, 2 were under invasive mechanical ventilation at surgery and 5 died within 30 days after surgery (13.2%) (not shown in tables).

Figure 1.

Kaplan-Meir curves for 30 -day postoperative survival in COVID-19 patients.
P = 0.118 by log-rank test

Impact on Surgical Care

During this 3-month long first wave of the pandemic, the total number of surgical procedures decreased by 50% as compared to the same time period in 2019 (22,616 cases in 2020 compared to 44,486 cases in 2019; Table 3). Of these 22,616 surgical cases, only 44 (0.19%) had COVID-19.

COVID-19 Suspected Patients and Patients who had Recovered From COVID-19

We included 18 suspected patients and 18 patients who had recovered from COVID-19 (Tables S2 and S3). Suspected patients had an incidence of pulmonary complications and new ICU admissions close to symptomatic COVID-19 patients but seemed to have a slightly lower 30-day mortality (16.7% versus 23.1%) (Table S3). One suspected patient suffered from a cardiac arrest and survived. Patients who had recovered from COVID-19 seemed to be comparable to asymptomatic patients regarding their complications profile (Tables S2 and S3). The observed difference in survival between COVID-19, suspected and patients who had recovered was not statistically significant (P = 0.55, Figure S1).

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