Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without

Several small studies have suggested that patients with positive test results for COVID-19 infection may experience worse perioperative outcomes and increased mortality after surgery. However, those studies were underpowered and lacked generalizability and comparative cohorts. This study by Haffner, et al. (2021) used data from a national database to compare the clinical outcomes of surgical patients testing positive for COVID-19 infection with those of a matched sample of surgical patients testing negative for COVID-19 infection. Elucidating the comparative surgical risk profiles of patients with and without COVID-19 infection would help health care systems to improve preoperative guidelines and clinicians to better inform patients in shared medical decision making before surgery.

This was a retrospective cohort study of hospital discharge data from the Vizient Clinical Data Base. Patients 18 years or older with and without COVID-19 infection who underwent surgery from April 1 through Nov. 30, 2020, were matched on a 1:1 ratio based on age and case mix index. Procedures among all surgical specialties were included. Patients who underwent gynecologic, obstetrical, or minor procedures (e.g., tracheostomy, percutaneous cardiovascular procedures) were excluded. Inpatient mortality, complications listed in the Vizient Clinical Data Base, patient safety indicators, hospital-acquired conditions, and length of stay were compared between the cohorts.

A total of 5,470 surgical patients with positive COVID-19 test results were matched with 5,470 surgical patients with negative COVID-19 test results during the same study period. Among all hospitals, there were more than double the number of deaths reported in the cohort of patients with COVID-19 (811 [14.8%]) compared with the cohort of patients without COVID-19 (388 [7.1%]) (P < .001). The rates of complications listed in the Vizient Clinical Data Base (818 [15.0%] vs 760 [13.9%]; P = .11) and median length of stay (10.0 [interquartile range (IQR), 1.3-36.4] vs 10.7 [IQR, 1.0-558.0] days; P = .86) did not differ significantly between the 2 groups. However, hospital-acquired conditions (110 [2.0%] vs 46 [0.8%]; P < .001) and patient safety indicators (183 [3.3%] vs 129 [2.4%]; P = .002) were higher in patients with COVID-19.

Within each hospital ownership type (public, private, nonprofit), more deaths occurred in the group with COVID-19 compared with the group without COVID-19 in public hospitals (146 [15.8%] vs 46 [4.8%]; P < .001) and nonprofit hospitals (631 [14.7%] vs 326 [7.5%]; P < .001), but not in private hospitals (34 [14.1%] vs 16 [9.4%]; P = .15). Among surgical patients with COVID-19, there were no differences in mortality rates, complications listed in the Vizient Clinical Data Base, hospital-acquired conditions, or patient safety indicators among public, private, or nonprofit hospitals.

Reference: Haffner MR, et al. Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection. JAMA Netw Open. 2021;4(4):e215697. doi:10.1001/jamanetworkopen.2021.5697

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