Patients who had documented or occult Covid-19 infection and underwent urgent and emergent surgery at two urban hospital systems in New York City during March 17 to April 15, 2020 were enrolled in a retrospective cohort study to determine the outcomes of surgery. The study was conducted when the infection was rampant in the area and all elective surgeries had been cancelled. Covid-19 positive for the study was defined as preoperative confirmed positive Covid-19 test or a confirmed positive Covid-19 test within 21 days (before or after) of the surgical procedure. Thirty-six (7.7%) of the 468 subjects recruited, had confirmed COVID-19 infection. Of these, 55.6% were identified before the surgery, while the remaining 44.4% were detected after the surgery.

The perioperative mortality rate was higher in Covid-19-positive participants vs those who tested negative for the virus; 16.7% vs 1.4%, respectively [aRR = 9.29; 95% confidence interval (CI), 5.68-15.21]. More Covid-19 patients reported serious complications as compared to controls; 58.3% vs 6.0% (aRR = 7.02; 95%CI, 4.96-9.92). Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were found to be more common in patients with Covid-19. Covid-19 patients also required intensive care compared to controls; the ICU admission rate was 36.1% vs 16.4%, respectively (aRR = 1.34; 95% CI, 0.86-2.09).

These findings are indicative of the risks that patients are exposed to when undergoing urgent and emergent surgical procedures due to Covid-19 infection. The study concluded that perioperative morbidity and mortality was higher in Covid-19 patients. A large number of patients are diagnosed postoperatively as was also the case in this study. Hence, symptomatic screening is not an accurate method to identify infected patients. Hence, there is a need for institutional protocols for preoperative laboratory-based screening of the patients preoperatively. The authors further suggest that given the high perioperative morbidity and mortality in these patients, conservative management and delaying surgery as much as feasible, should be considered.

Source: Knisely A, et al. Ann Surg. 2021 Jan 1;273(1):34-40.