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 language | English (US) |
---|---|
Pages (from-to) | 513-524 |
Number of pages | 12 |
Journal | Journal of Trauma and Acute Care Surgery |
Volume | 94 |
Issue number | 4 |
DOIs | |
State | Published - Apr 1 2023 |
Externally published | Yes |
Keywords
- COVID-19
- COVIDSurg
- mortality
- postoperative complications
ASJC Scopus subject areas
- Surgery
- Critical Care and Intensive Care Medicine
Access to Document
Other files and links
Fingerprint
Dive into the research topics of 'Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis'. Together they form a unique fingerprint.Cite this
- APA
- Standard
- Harvard
- Vancouver
- Author
- BIBTEX
- RIS
In: Journal of Trauma and Acute Care Surgery, Vol. 94, No. 4, 01.04.2023, p. 513-524.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis
AU - Argandykov, Dias
AU - Dorken-Gallastegi, Ander
AU - El Moheb, Mohamad
AU - Gebran, Anthony
AU - Proaño-Zamudio, Jefferson A.
AU - Bokenkamp, Mary
AU - Renne, Angela M.
AU - Nepogodiev, Dmitri
AU - Bhangu, Aneel
AU - Kaafarani, Haytham M.A.
AU - Siaw-Acheampong, Kwabena
AU - Argus, Leah
AU - Chaudhry, Daoud
AU - Dawson, Brett E.
AU - Glasbey, James C.
AU - Gujjuri, Rohan R.
AU - Jones, Conor S.
AU - Kamarajah, Sivesh K.
AU - Khatri, Chetan
AU - Keatley, James M.
AU - Lawday, Samuel
AU - Li, Elizabeth
AU - Mann, Harvinder
AU - Marson, Ella J.
AU - McLean, Kenneth A.
AU - Picciochi, Maria
AU - Taylor, Elliott H.
AU - Tiwari, Abhinav
AU - Simoes, Joana F.F.
AU - Trout, Isobel M.
AU - Venn, Mary L.
AU - Wilkin, Richard J.W.
AU - Bhangu, Aneel
AU - Nepogodiev, Dmitri
AU - Dajti, Irida
AU - Gjata, Arben
AU - Boccalatte, Luis
AU - Modolo, Mariamarta
AU - Cox, Daniel
AU - Pockney, Peter
AU - Townend, Philip
AU - Aigner, Felix
AU - Kronberger, Irmgard
AU - Hossain, Kamral
AU - Vanramshorst, Gabrielle
AU - Lawani, Ismail
AU - Ataide, Gustavo
AU - Baiocchi, Glauco
AU - Buarque, Igor
AU - Gohar, Muhammad
AU - Slavchev, Mihail
AU - Agarwal, Arnav
AU - Brar, Amanpreet
AU - Martin, Janet
AU - Modolo, Maria Marta
AU - Olivos, Maricarmen
AU - Calvache, Jose
AU - Rivera, Carlos Jose Perez
AU - Hadzibegovic, Ana Danic
AU - Kopjar, Tomislav
AU - Mihanovic, Jakov
AU - Klat, Jaroslav
AU - Novysedlak, René
AU - Christensen, Peter
AU - El-Hussuna, Alaa
AU - Batista, Sylvia
AU - Lincango, Eddy
AU - Emile, Sameh H.
AU - Mengesha, Mengistu Gebreyohanes
AU - Hailu, Samuel
AU - Tamiru, Hailu
AU - Kauppila, Joonas
AU - Laukkarinen, Johanna
AU - Arnaud, Alexis
AU - Albertsmeiers, Markus
AU - Lederhuber, Hans
AU - Loffler, Markus
AU - Tabiri, Stephen
AU - Metallidis, Symeon
AU - Tsoulfas, Georgios
AU - Lorena, Maria Aguilera
AU - Grecinos, Gustavo
AU - Mersich, Tamas
AU - Wettstein, Daniel
AU - Ghosh, Dhruv
AU - Kembuan, Gabriele
AU - Brouk, Peiman
AU - Khosravi, Mohammad
AU - Mozafari, Masoud
AU - Adil, Ahmed
AU - Mohan, Helen M.
AU - Zmora, Oded
AU - Fiore, Marco
AU - Gallo, Gaetano
AU - Pata, Francesco
AU - Pellino, Gianluca
AU - Satoi, Sohei
AU - Ayasra, Faris
AU - Chaar, Mohammad
AU - Fakhradiyev, Ildar R.
AU - Jamal, Mohammad
AU - Elhadi, Muhammed
AU - Gulla, Aiste
AU - Roslani, April
AU - Martinez, Laura
AU - De La Medina, Antonio Ramos
AU - Outani, Oumaima
AU - Jonker, Pascal
AU - Kruijff, Schelto
AU - Noltes, Milou
AU - Steinkamp, Pieter
AU - Van Der Plas, Willemijn
AU - Ademuyiwa, Adesoji
AU - Osinaike, Babatunde
AU - Seyi-Olajide, Justina
AU - Williams, Emmanuel
AU - Pejkova, Sofija
AU - Augestad, Knut Magne
AU - Al Balushi, Zainab
AU - Qureshi, Ahmad
AU - Sayyed, Raza
AU - Daraghmeh, Mustafa Abu Mohsen
AU - Abukhalaf, Sadi
AU - Cukier, Moises
AU - Gomez, Hugo
AU - Shu, Sebastian
AU - Vasquez, Ximena
AU - Parreno-Sacdalan, Marie Dione
AU - Major, Piotr
AU - Azevedo, José
AU - Cunha, Miguel
AU - Santos, Irene
AU - Zarour, Ahmad
AU - Bonci, Eduard Alexandru
AU - Negoi, Ionut
AU - Efetov, Sergey
AU - Litvin, Andrey
AU - Ntirenganya, Faustin
AU - Alameer, Ehab
AU - Radenkovic, Dejan
AU - Xiang, Frederick Koh Hong
AU - Hoe, Chew Min
AU - Yong, James Ngu Chi
AU - Moore, Rachel
AU - Nhlabathi, Ncamsile
AU - Colino, Ruth Blanco
AU - Bravo, Ana Minaya
AU - Minaya-Bravo, Ana
AU - Jayarajah, Umesh
AU - Wickramasinghe, Dakshitha
AU - Elmujtaba, Mohammed
AU - Jebril, William
AU - Rutegård, Martin
AU - Sund, Malin
AU - Isik, Arda
AU - Leventoǧlu, Sezai
AU - Abbott, Tom E.F.
AU - Benson, Ruth
AU - Caruna, Ed
AU - Chakrabortee, Sohini
AU - Demetriades, Andreas
AU - Desai, Anant
AU - Drake, Thomas D.
AU - Edwards, John G.
AU - Evans, Jonathan P.
AU - Ford, Samuel
AU - Fotopoulou, Christina
AU - Griffiths, Ewen
AU - Hutchinson, Peter
AU - Jenkinson, Michael D.
AU - Khan, Tabassum
AU - Knight, Stephen
AU - Kolias, Angelos
AU - Leung, Elaine
AU - McKay, Siobhan
AU - Norman, Lisa
AU - Ots, Riinu
AU - Raghavan, Vidya
AU - Roberts, Keith
AU - Schache, Andrew
AU - Shaw, Richard
AU - Shaw, Katie
AU - Smart, Neil
AU - Stewart, Grant
AU - Sundar, Sudha
AU - Vimalchandran, Dale
AU - Wright, Naomi
AU - Alshryda, Sattar
AU - Alser, Osaid
AU - Breen, Kerry
AU - Ganly, Ian
AU - Kaafarani, Haytham
AU - Kendall, Brittany
AU - Mashbari, Hassan
AU - Al Naggar, Hamza
AU - Mazingi, Dennis
AU - Wong, J. J.
AU - Napolitano, L.
AU - Hemmila, M.
AU - Amin, D.
AU - Abramowicz, S.
AU - Roser, S. M.
AU - Olson, K. A.
AU - Riley, C.
AU - Heron, C.
AU - Cardenas, T.
AU - Leede, E.
AU - Thornhill, M.
AU - Haynes, A. B.
AU - McElhinney, K.
AU - Roward, S.
AU - Trust, M. D.
AU - Hill, C. E.
AU - Teixeira, P. G.
AU - Etchill, E.
AU - Stevens, K.
AU - Ladd, M. R.
AU - Long, C.
AU - Rose, J.
AU - Kent, A.
AU - Yesantharao, P.
AU - Vervoort, D.
AU - Jenny, H.
AU - Gabre-Kidan, A.
AU - Margalit, A.
AU - Tsai, L.
AU - Malapati, H.
AU - Yesantharao, L.
AU - Abdou, H.
AU - Diaz, J.
AU - Richmond, M.
AU - Clark, J.
AU - O'Meara, L.
AU - Hanna, N.
AU - Ying, Y.
AU - Fleming, J.
AU - Ovaitt, A.
AU - Gigliotti, J.
AU - Fuson, A.
AU - Cooper, Z.
AU - Salim, A.
AU - Hirji, S. A.
AU - Brown, A.
AU - Chung, C.
AU - Hansen, L.
AU - Okafor, B. U.
AU - Roxo, V.
AU - Raut, C. P.
AU - Jolissaint, J. S.
AU - Mahvi, D. A.
AU - Kaafarani, H.
AU - Breen, K.
AU - Bankhead-Kendall, B.
AU - Alser, O.
AU - Mashbari, H.
AU - Velmahos, G.
AU - Maurer, L. R.
AU - MEl Moheb, M.
AU - Gaitanidis, A.
AU - Naar, L.
AU - Christensen, M. A.
AU - Kapoen, C.
AU - Langeveld, K.
AU - El Hechi, M.
AU - Mokhtari, A.
AU - Haqqani, M. H.
AU - Drake, F. T.
AU - Goldenberg-Sandau, A.
AU - Galbreath, B.
AU - Reinke, C.
AU - Ross, S.
AU - Thompson, K.
AU - Manning, D.
AU - Perkins, R.
AU - Eriksson, E.
AU - Evans, H.
AU - Masrur, M.
AU - Giulianotti, P.
AU - Benedetti, E.
AU - Chang, G.
AU - Ourieff, J.
AU - Dehart, D.
AU - Dorafshar, A.
AU - Price, T.
AU - Bhama, A. R.
AU - Torquati, A.
AU - Cherullo, E.
AU - Kennedy, R.
AU - Myers, J.
AU - Rubin, K.
AU - Ban, V. S.
AU - Aoun, S. G.
AU - Batjer, H. H.
AU - Caruso, J.
AU - Carmichael, H.
AU - Velopulos, C. G.
AU - Wright, F. L.
AU - Urban, S.
AU - McIntyre, R. C.
AU - Schroeppel, T. J.
AU - Hennessy, E. A.
AU - Dunn, J.
AU - Zier, L.
AU - Burlew, C.
AU - Coleman, J.
AU - Colling, K. P.
AU - Hall, B.
AU - Rice, H. E.
AU - Hwang, E. S.
AU - Olson, S. A.
AU - Moris, D.
AU - Verma, R.
AU - Hassan, R.
AU - Volpe, A.
AU - Merola, S.
AU - O'Banion, L. A.
AU - Lilienstein, J.
AU - Dirks, R.
AU - Marwan, H.
AU - Almasri, M.
AU - Kulkarni, G.
AU - Mehdi, M.
AU - Abouassi, A.
AU - Abdallah, M.
AU - San Andrés, M.
AU - Eid, J.
AU - Aigbivbalu, E.
AU - Sundaresan, J.
AU - George, B.
AU - Ssentongo, A.
AU - Ssentongo, P.
AU - Oh, J. S.
AU - Hazelton, J.
AU - Maines, J.
AU - Gusani, N.
AU - Garner, M.
AU - Horvath, S.
AU - Zheng, F.
AU - Ujiki, M.
AU - Kinnaman, G.
AU - Meagher, A.
AU - Sharma, I.
AU - Holler, E.
AU - McKenzie, K.
AU - Chan, J.
AU - Fretwell, K.
AU - Nugent, W.
AU - Khalil, A.
AU - Chen, D.
AU - Post, N.
AU - Rostkowski, T.
AU - Brahmbhatt, D.
AU - Huynh, K.
AU - Hibbard, M. L.
AU - Schellenberg, M.
AU - Rcg, Martin
AU - Bhutiani, N.
AU - Giorgakis, E.
AU - Laryea, J.
AU - Bhavaraju, A.
AU - Sexton, K.
AU - Roberts, M.
AU - Kost, M.
AU - Kimbrough, M.
AU - Burdine, L.
AU - Kalkwarf, K.
AU - Robertson, R.
AU - Gosain, A.
AU - Camp, L.
AU - Lewit, R.
AU - Kronenfeld, J. P.
AU - Urrechaga, E.
AU - Goel, N.
AU - Rattan, R.
AU - Hart, V.
AU - Gilna, G.
AU - Cioci, A.
AU - Ruiz, G.
AU - Allen, M.
AU - Rakoczy, K.
AU - Pavlis, W.
AU - Saberi, R.
AU - Morris, R.
AU - Karam, B. S.
AU - Cem, Brathwaite
AU - Liu, H.
AU - Petrone, P.
AU - Hakmi, H.
AU - Sohail, A. H.
AU - Baltazar, G.
AU - Heckburn, R.
AU - Nygaard, R. M.
AU - Colonna, E. T.
AU - Endorf, F. W.
AU - Hill, M. J.
AU - Maiga, A.
AU - Dennis, B.
AU - Levin, J. H.
AU - Lallemand, M.
AU - Choron, R.
AU - Peck, G.
AU - Soliman, F.
AU - Rehman, S.
AU - Glass, N.
AU - Juthani, B.
AU - Deisher, D.
AU - Ruzgar, N. M.
AU - Ullrich, S. J.
AU - Sion, M.
AU - Paranjape, C.
AU - El Moheb, M.
AU - Kar, A. R.
AU - Gillezeau, C.
AU - Rapp, J.
AU - Taioli, E.
AU - Miles, B. A.
AU - Alpert, N.
AU - Podolsky, D.
AU - Coleman, N. L.
AU - Callahan, M. P.
AU - Ganly, I.
AU - Brown, L.
AU - Jrt, Monson
AU - Dehal, A.
AU - Abbas, A.
AU - Soliman, A.
AU - Kim, B.
AU - Jones, C.
AU - Dauer, E.
AU - Renza-Stingone, E.
AU - Hernandez, E.
AU - Gokcen, E.
AU - Kropf, E.
AU - Sufrin, H.
AU - Hirsch, H.
AU - Ross, H.
AU - Engel, J.
AU - Sewards, J.
AU - Poggio, J.
AU - Sanserino, K.
AU - Rae, L.
AU - Philp, M.
AU - Metro, M.
AU - McNelis, P.
AU - Petrov, R.
AU - Pazionis, T.
AU - Till, B.
AU - Lamm, R.
AU - Rios-Diaz, A. J.
AU - Palazzo, F.
AU - Rosengart, M.
AU - Nicholson, K.
AU - Carrick, M. M.
AU - Rodkey, K.
AU - Suri, A.
AU - Callcut, R.
AU - Nicholson, S.
AU - Talathoti, N.
AU - Klaristenfeld, D.
AU - Biffl, W.
AU - Marsh, C.
AU - Schaffer, K.
AU - Berndtson, A. E.
AU - Averbach, S.
AU - Curry, T.
AU - Kwan-Feinberg, R.
AU - Consorti, E.
AU - Gonzalez, R.
AU - Grolman, R.
AU - Liu, T.
AU - Merzlikin, O.
AU - Abel, M. K.
AU - Ozgediz, D.
AU - Boeck, M.
AU - Kornblith, L. Z.
AU - Nunez-Garcia, B.
AU - Robinson, B.
AU - Park, P.
AU - Utria, A. F.
AU - Rice-Townsend, S. E.
AU - Javid, P.
AU - Hauptman, J.
AU - Kieran, K.
AU - Nehra, D.
AU - Walters, A.
AU - Cuschieri, J.
AU - Davidson, G. H.
AU - Nunez, J.
AU - Cosker, R.
AU - Eckhouse, S.
AU - Choudhry, A.
AU - Marx, W.
AU - Jamil, T.
AU - Seegert, S.
AU - Al-Embideen, S.
AU - Quintana, M.
AU - Jackson, H.
AU - Wexner, S. D.
AU - Kent, I.
AU - Martins, P. N.
N1 - Publisher Copyright: © Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - COVIDSurg
KW - mortality
KW - postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=85150765803&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150765803&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000003859
DO - 10.1097/TA.0000000000003859
M3 - Article
C2 - 36949053
AN - SCOPUS:85150765803
SN - 2163-0755
VL - 94
SP - 513
EP - 524
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 4
ER -