Objective: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA. Background: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists. Methods: As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality. Results: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]). Conclusions: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.
Outcomes and Their State-level Variation in Patients Undergoing Surgery With Perioperative SARS-CoV-2 Infection in the USA. A Prospective Multicenter Study / Osaid, Alser; Ander Dorken, Gallastegi; Anthony, Gebran; Kerry, Breen; Mohamad El, Moheb; Apostolos, Gaitanidis; Leon, Naar; Brittany, Bankhead-Kendall; Hassan, Mashbari; Robert, D Sinyard; Lydia, R Maurer; Charu, Paranjape; George, C Velmahos; 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 Keatley; Samuel, 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; Oussama, Kacimi; Luis, Boccalatte; Maria Marta, Modolo; Daniel, Cox; Peter, Pockney; Philip, Townend; Felix, Aigner; Irmgard, Kronberger; Ahmed, Elgun; Amer, Alderazi; Kamral, Hossain; Greg, Padmore; Gabrielle, Vanramshorst; Ismail, Lawani; Duane, Wedderburn; Sonam, Dargay; Israël, Feraudy; Cerovac, Anis; Samir, Delibegovic; Alemayehu Ginbo, Bedada; Gustavo, Ataide; Glauco, Baiocchi; Igor, Buarque; Muhammad, Gohar; Mihail, Slavchev; Jean Marie Vianney, Butoyi; Chukwuemeka, Nwegbu; Arnav, Agarwal; Amanpreet, Brar; Janet, Martin; Maria Marta, Modolo; Maricarmen, Olivos; Dong-Lin, Ren; Wenhui, Lou; Jose, Calvache; Carlos Jose Perez, Rivera; Ana Danic, Hadzibegovic; Tomislav, Kopjar; Jakov, Mihanovic; Pablo, Avilés; Nikolaos, Gouvas; Jaroslav, Klat; René, Novysedlak; Nicolas, Amisi; Peter, Christensen; Alaa, El-Hussuna; Sylvia, Batista; Eddy, Lincango; Sameh, H Emile; Danilo Alfonso Arévalo, Sandoval; Mengistu Gebreyohanes, Mengesha; Samuel, Hailu; Hailu, Tamiru; Joonas, Kauppila; Johanna, Laukkarinen; Alexis, Arnaud; Roumanatou Bankole, Sapin; Kebba, Marenah; Zaza, Demetrashvili; Andreas, A Schnitzbauer; Magdalena, Gruendl; Markus, Albertsmeiers; Hans, Lederhuber; Markus, Loffler; Bernard Ofori, Appiah; Daniel, Acquah; Stephen, Tabiri; Symeon, Metallidis; Georgios, Tsoulfas; Maria Aguilera, Lorena; Gustavo, Grecinos; Tamas, Mersich; Daniel, Wettstein; Atul, Suroy; Dhruv, Ghosh; Pranay, Pawar; Gabriele, Kembuan; Peiman, Brouk; Mohammad, Khosravi; Masoud, Mozafari; Ahmed, Adil; Helen, M Mohan; Oded, Zmora; Marco, Fiore; Gallo, G; Francesco, Pata; Gianluca, Pellino; Naoto, Kuroda; Sohei, Satoi; Yuki, Fujimoto; Faris, Ayasra; Mohammad, Chaar; Ildar, R Fakhradiyev; Intisar, Hisham; Jin-Young, Jang; Enver, Fekaj; Mohammad, Jamal; Anvar, Beisembaev; Muhammed, Elhadi; Aiste, Gulla; Luc, Samison; Jupsi, Neny; Palesa, Chisala; April, Roslani; Iran Irani Duran, Sanchez; Laura Martinez Perez, Maldonado; Antonio Ramos De La, Medina; Jade, Nunez; Oumaima, Outani; Abd'Rashid, Nashidengo; Ashish Lal, Shrestha; Rakesh, Shah; Pascal, Jonker; Schelto, Kruijff; Milou, Noltes; Pieter, Steinkamp; Willemijn Van Der, Plas; Chris, Varghese; Deborah, Wright; Jorge, Neira; Adesoji, Ademuyiwa; Babatunde, Osinaike; Justina, Seyi-Olajide; Emmanuel, Williams; Sofija, Pejkova; Knut Magne, Augestad; Kjetil, Soreide; Zainab Al, Balushi; Ahmad, Qureshi; Raza, Sayyed; Mustafa Abu Mohsen, Daraghmeh; Sadi, Abukhalaf; Moises, Cukier; Chris, Munguas; 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; Abdourahmane, Ndong; Dejan, Radenkovic; Ibrahim, Sesay; Frederick Koh Hong, Xiang; Chew Min, Hoe; James Ngu Chi, Yong; Arpad, Panyko; Jurij, Kosir; Uros, Bele; Hassan, Ali; Rachel, Moore; Ncamsile, Nhlabathi; Ruth Blanco, Colino; Ana Minaya, Bravo; Umesh, Jayarajah; Dakshitha, Wickramasinghe; Mohammed, Elmujtaba; William, Jebril; Martin, Rutegård; Malin, Sund; Eleftherios, Gialamas; Karoline, Horisberger; Michel, Adamina; Muhammad, Alshaar; Abel, Huang; Ben, Mbwele; Varut, Lohsiriwat; Shane, Charles; Haithem, Jlassi; Arda, Isik; Sezai, Leventoğlu; Lekuya, Herve; Lekuya, Monka; Herman, Lule; 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; Slava, Kopetskiy; Sattar, Alshryda; Osaid, Alser; Kerry, Breen; Ian, Ganly; Haytham, Kaafarani; Brittany, Kendall; Hassan, Mashbari; Fernando, Bonilla; Hamza Al, Naggar; Mayaba, Maimbo; Dennis, Mazingi; Joana F, F Simoes; 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 El, 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 Jr; 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, 3rd; A, Khalil; D, Chen; N, Post; T, Rostkowski; D, Brahmbhatt; K, Huynh; M, L Hibbard; M, Schellenberg; R C, G Martin; 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; M, Allen; G, Gilna; A, Cioci; G, Ruiz; M, Allen; K, Rakoczy; W, Pavlis; R, Saberi; R, Morris; B, S Karam; C E, M Brathwaite; 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; J R, T Monson; A, Dehal; A, Abbas; A, Soliman; B, Kim; C, Jones; M, D Dauer; E, Renza-Stingone; E, Hernandez; E, Gokcen; E, Kropf; H, Sufrin; H, Hirsch; H, Ross; J, Engel; J, Sewards; J, Diaz; J, Poggio; K, Sanserino; L, Rae; M, Philp; M, Metro; P, Mcnelis; R, Petrov; S, Rehman; 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; Xiao, Liu; Alistair, Denniston. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - 275:2(2022), pp. 247-251. [10.1097/SLA.0000000000005310]
Outcomes and Their State-level Variation in Patients Undergoing Surgery With Perioperative SARS-CoV-2 Infection in the USA. A Prospective Multicenter Study
Gallo G;
2022-01-01
Abstract
Objective: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA. Background: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists. Methods: As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality. Results: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]). Conclusions: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
