Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis

Dias Argandykov, Ander Dorken-Gallastegi, Mohamad El Moheb, Anthony Gebran, Jefferson A. Proaño-Zamudio, Mary Bokenkamp, Angela M. Renne, Dmitri Nepogodiev, Aneel Bhangu, Haytham M.A. Kaafarani, Kwabena Siaw-Acheampong, Leah Argus, Daoud Chaudhry, Brett E. Dawson, James C. Glasbey, Rohan R. Gujjuri, Conor S. Jones, Sivesh K. Kamarajah, Chetan Khatri, James M. KeatleySamuel Lawday, Elizabeth Li, Harvinder Mann, Ella J. Marson, Kenneth A. McLean, Maria Picciochi, Elliott H. Taylor, Abhinav Tiwari, Joana F.F. Simoes, Isobel M. Trout, Mary L. Venn, Richard J.W. Wilkin, Aneel Bhangu, Dmitri Nepogodiev, Irida Dajti, Arben Gjata, Luis Boccalatte, Mariamarta Modolo, Daniel Cox, Peter Pockney, Philip Townend, Felix Aigner, Irmgard Kronberger, Kamral Hossain, Gabrielle Vanramshorst, Ismail Lawani, Gustavo Ataide, Glauco Baiocchi, Igor Buarque, Muhammad Gohar, Mihail Slavchev, Arnav Agarwal, Amanpreet Brar, Janet Martin, Maria Marta Modolo, Maricarmen Olivos, Jose Calvache, Carlos Jose Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Jaroslav Klat, René Novysedlak, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango, Sameh H. Emile, Mengistu Gebreyohanes Mengesha, Samuel Hailu, Hailu Tamiru, Joonas Kauppila, Johanna Laukkarinen, Alexis Arnaud, Markus Albertsmeiers, Hans Lederhuber, Markus Loffler, Stephen Tabiri, Symeon Metallidis, Georgios Tsoulfas, Maria Aguilera Lorena, Gustavo Grecinos, Tamas Mersich, Daniel Wettstein, Dhruv Ghosh, Gabriele Kembuan, Peiman Brouk, Mohammad Khosravi, Masoud Mozafari, Ahmed Adil, Helen M. Mohan, Oded Zmora, Marco Fiore, Gaetano Gallo, Francesco Pata, Gianluca Pellino, Sohei Satoi, Faris Ayasra, Mohammad Chaar, Ildar R. Fakhradiyev, Mohammad Jamal, Muhammed Elhadi, Aiste Gulla, April Roslani, Laura Martinez, Antonio Ramos De La Medina, Oumaima Outani, Pascal Jonker, Schelto Kruijff, Milou Noltes, Pieter Steinkamp, Willemijn Van Der Plas, Adesoji Ademuyiwa, Babatunde Osinaike, Justina Seyi-Olajide, Emmanuel Williams, Sofija Pejkova, Knut Magne Augestad, Zainab Al Balushi, Ahmad Qureshi, Raza Sayyed, Mustafa Abu Mohsen Daraghmeh, Sadi Abukhalaf, Moises Cukier, Hugo Gomez, Sebastian Shu, Ximena Vasquez, Marie Dione Parreno-Sacdalan, Piotr Major, José Azevedo, Miguel Cunha, Irene Santos, Ahmad Zarour, Eduard Alexandru Bonci, Ionut Negoi, Sergey Efetov, Andrey Litvin, Faustin Ntirenganya, Ehab Alameer, Dejan Radenkovic, Frederick Koh Hong Xiang, Chew Min Hoe, James Ngu Chi Yong, Rachel Moore, Ncamsile Nhlabathi, Ruth Blanco Colino, Ana Minaya Bravo, Ana Minaya-Bravo, Umesh Jayarajah, Dakshitha Wickramasinghe, Mohammed Elmujtaba, William Jebril, Martin Rutegård, Malin Sund, Arda Isik, Sezai Leventoǧlu, Tom E.F. Abbott, Ruth Benson, Ed Caruna, Sohini Chakrabortee, Andreas Demetriades, Anant Desai, Thomas D. Drake, John G. Edwards, Jonathan P. Evans, Samuel Ford, Christina Fotopoulou, Ewen Griffiths, Peter Hutchinson, Michael D. Jenkinson, Tabassum Khan, Stephen Knight, Angelos Kolias, Elaine Leung, Siobhan McKay, Lisa Norman, Riinu Ots, Vidya Raghavan, Keith Roberts, Andrew Schache, Richard Shaw, Katie Shaw, Neil Smart, Grant Stewart, Sudha Sundar, Dale Vimalchandran, Naomi Wright, Sattar Alshryda, Osaid Alser, Kerry Breen, Ian Ganly, Haytham Kaafarani, Brittany Kendall, Hassan Mashbari, Hamza Al Naggar, Dennis Mazingi, J. J. Wong, L. Napolitano, M. Hemmila, D. Amin, S. Abramowicz, S. M. Roser, K. A. Olson, C. Riley, C. Heron, T. Cardenas, E. Leede, M. Thornhill, A. B. Haynes, K. McElhinney, S. Roward, M. D. Trust, C. E. Hill, P. G. Teixeira, E. Etchill, K. Stevens, M. R. Ladd, C. Long, J. Rose, A. Kent, P. Yesantharao, D. Vervoort, H. Jenny, A. Gabre-Kidan, A. Margalit, L. Tsai, H. Malapati, L. Yesantharao, H. Abdou, J. Diaz, M. Richmond, J. Clark, L. O'Meara, N. Hanna, Y. Ying, J. Fleming, A. Ovaitt, J. Gigliotti, A. Fuson, Z. Cooper, A. Salim, S. A. Hirji, A. Brown, C. Chung, L. Hansen, B. U. Okafor, V. Roxo, C. P. Raut, J. S. Jolissaint, D. A. Mahvi, H. Kaafarani, K. Breen, B. Bankhead-Kendall, O. Alser, H. Mashbari, G. Velmahos, L. R. Maurer, M. MEl Moheb, A. Gaitanidis, L. Naar, M. A. Christensen, C. Kapoen, K. Langeveld, M. El Hechi, A. Mokhtari, M. H. Haqqani, F. T. Drake, A. Goldenberg-Sandau, B. Galbreath, C. Reinke, S. Ross, K. Thompson, D. Manning, R. Perkins, E. Eriksson, H. Evans, M. Masrur, P. Giulianotti, E. Benedetti, G. Chang, J. Ourieff, D. Dehart, A. Dorafshar, T. Price, A. R. Bhama, A. Torquati, E. Cherullo, R. Kennedy, J. Myers, K. Rubin, V. S. Ban, S. G. Aoun, H. H. Batjer, J. Caruso, H. Carmichael, C. G. Velopulos, F. L. Wright, S. Urban, R. C. McIntyre, T. J. Schroeppel, E. A. Hennessy, J. Dunn, L. Zier, C. Burlew, J. Coleman, K. P. Colling, B. Hall, H. E. Rice, E. S. Hwang, S. A. Olson, D. Moris, R. Verma, R. Hassan, A. Volpe, S. Merola, L. A. O'Banion, J. Lilienstein, R. Dirks, H. Marwan, M. Almasri, G. Kulkarni, M. Mehdi, A. Abouassi, M. Abdallah, M. San Andrés, J. Eid, E. Aigbivbalu, J. Sundaresan, B. George, A. Ssentongo, P. Ssentongo, J. S. Oh, J. Hazelton, J. Maines, N. Gusani, M. Garner, S. Horvath, F. Zheng, M. Ujiki, G. Kinnaman, A. Meagher, I. Sharma, E. Holler, K. McKenzie, J. Chan, K. Fretwell, W. Nugent, A. Khalil, D. Chen, N. Post, T. Rostkowski, D. Brahmbhatt, K. Huynh, M. L. Hibbard, M. Schellenberg, Martin Rcg, N. Bhutiani, E. Giorgakis, J. Laryea, A. Bhavaraju, K. Sexton, M. Roberts, M. Kost, M. Kimbrough, L. Burdine, K. Kalkwarf, R. Robertson, A. Gosain, L. Camp, R. Lewit, J. P. Kronenfeld, E. Urrechaga, N. Goel, R. Rattan, V. Hart, G. Gilna, A. Cioci, G. Ruiz, M. Allen, K. Rakoczy, W. Pavlis, R. Saberi, R. Morris, B. S. Karam, Brathwaite Cem, H. Liu, P. Petrone, H. Hakmi, A. H. Sohail, G. Baltazar, R. Heckburn, R. M. Nygaard, E. T. Colonna, F. W. Endorf, M. J. Hill, A. Maiga, B. Dennis, J. H. Levin, M. Lallemand, R. Choron, G. Peck, F. Soliman, S. Rehman, N. Glass, B. Juthani, D. Deisher, N. M. Ruzgar, S. J. Ullrich, M. Sion, C. Paranjape, M. El Moheb, A. R. Kar, C. Gillezeau, J. Rapp, E. Taioli, B. A. Miles, N. Alpert, D. Podolsky, N. L. Coleman, M. P. Callahan, I. Ganly, L. Brown, Monson Jrt, A. Dehal, A. Abbas, A. Soliman, B. Kim, C. Jones, E. Dauer, E. Renza-Stingone, E. Hernandez, E. Gokcen, E. Kropf, H. Sufrin, H. Hirsch, H. Ross, J. Engel, J. Sewards, J. Poggio, K. Sanserino, L. Rae, M. Philp, M. Metro, P. McNelis, R. Petrov, T. Pazionis, B. Till, R. Lamm, A. J. Rios-Diaz, F. Palazzo, M. Rosengart, K. Nicholson, M. M. Carrick, K. Rodkey, A. Suri, R. Callcut, S. Nicholson, N. Talathoti, D. Klaristenfeld, W. Biffl, C. Marsh, K. Schaffer, A. E. Berndtson, S. Averbach, T. Curry, R. Kwan-Feinberg, E. Consorti, R. Gonzalez, R. Grolman, T. Liu, O. Merzlikin, M. K. Abel, D. Ozgediz, M. Boeck, L. Z. Kornblith, B. Nunez-Garcia, B. Robinson, P. Park, A. F. Utria, S. E. Rice-Townsend, P. Javid, J. Hauptman, K. Kieran, D. Nehra, A. Walters, J. Cuschieri, G. H. Davidson, J. Nunez, R. Cosker, S. Eckhouse, A. Choudhry, W. Marx, T. Jamil, S. Seegert, S. Al-Embideen, M. Quintana, H. Jackson, S. D. Wexner, I. Kent, P. N. Martins

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)513-524
Number of pages12
JournalJournal of Trauma and Acute Care Surgery
Volume94
Issue number4
DOIs
StatePublished - 1 Apr 2023
Externally publishedYes

Keywords

  • COVID-19
  • COVIDSurg
  • mortality
  • postoperative complications

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