Department of Surgery & Cancer, Imperial College London, London, United Kingdom.
Imperial College Healthcare NHS Trust, London, United Kingdom.
Ann Surg. 2021 Dec 1;274(6):904-912. doi: 10.1097/SLA.0000000000005152.
The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort.
High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified.
PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented.
Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18.87), ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing.
The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.
PREDICT 研究旨在确定 COVID-19 大流行如何影响外科服务和外科患者，并确定该队列患者的结局预测因素。
在大流行的早期阶段，患有 COVID-19 的外科患者的死亡率很高。然而，人们并不了解大流行对这一人群的间接影响，也尚未确定风险预测因素。
PREDICT 是一项国际性的纵向队列研究，纳入 2020 年 3 月至 8 月期间住院的外科患者，同时进行了工作人员重新部署和部门结构调整调查。对来自 18 个国家的 55 个团队招募的 3176 例成年急诊患者进行了亚组分析。
在成年急诊外科患者中，全因住院死亡率（IHM）为 3.6%，而 COVID-19 患者为 15.5%。然而，3 月仅 14.1%的患者在入院时接受了 COVID-19 检测，到 7 月增加到 76.5%。较高的临床虚弱评分（CFS >7，aOR 18.87）、ASA 分级 2 级以上（aOR 4.29）和 COVID-19 感染（aOR 5.12）与显著增加的 IHM 独立相关。第一波的高峰月份与显著较高的 IHM 独立相关（3 月 aOR 4.34；4 月 aOR 4.25；5 月 aOR 3.97），与非高峰月份相比。在研究期间，英国手术室容量平均减少了 63.6%，手术人员减少了 27.3%。
COVID-19 大流行的第一波浪潮对外科患者产生了重大影响，既直接通过合并感染，也间接通过高峰月份死亡率的增加产生影响，无论 COVID-19 状态如何。较高的 CFS 评分和 ASA 分级强烈预测外科患者的结局，是大流行期间重要的风险评估工具。
