From the Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery (D.A., A.D.-G., M.E., A.G., J.A.P.-Z., M.B., A.M.R., H.M.A.K.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; NIHR Global Health Research Unit on Global Surgery, University of Birmingham (D.N., A.B.), Birmingham, United Kingdom.
J Trauma Acute Care Surg. 2023 Apr 1;94(4):513-524. doi: 10.1097/TA.0000000000003859. Epub 2023 Jan 19.
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.
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).
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).
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.
Prognostic and Epidemiologic; Level IV.
接受围手术期新冠病毒感染（COVID-19）的患者术后结局较差，但这是与 COVID-19 相关还是由于选择偏倚尚不清楚。我们旨在比较围手术期 COVID-19 患者与无 COVID-19 患者的术后结局。
2020 年 2 月至 7 月，COVIDSurg 国际多中心数据库纳入 68 家美国医院中 7 天内术前或术后 30 天内确诊围手术期 COVID-19 的患者，并按照美国外科医师学会国家外科质量改进计划数据库中类似手术 2012 年的 1:1 倾向评分匹配无 COVID-19 的患者。匹配标准包括人口统计学特征（如年龄、性别）、合并症（如糖尿病、慢性阻塞性肺疾病、慢性肾脏病）和手术特征（如类型、紧急程度、复杂性）。主要结局为 30 天院内死亡率。次要结局包括住院时间和 13 种术后并发症（如肺炎、肾衰竭、手术部位感染）。
共纳入 97936 例患者，其中 1054 例合并 COVID-19，96882 例无 COVID-19。术前，COVID-19 患者更常接受急诊手术（76.1% vs. 10.3%，p < 0.001）。根据人口统计学特征、合并症和手术特征，共对 843 例 COVID-19 患者和 843 例非 COVID-19 患者进行了成功匹配。匹配后，COVID-19 患者死亡率更高（12.0% vs. 8.1%，p = 0.007），住院时间更长（6 [2-15] vs. 5 [1-12]天），急性肾衰竭（19.3% vs. 3.0%，p < 0.001）、脓毒症（13.5% vs. 9.0%，p = 0.003）和感染性休克（11.8% vs. 6.0%，p < 0.001）发生率更高。COVID-19 患者深静脉血栓形成（4.4% vs. 1.5%，p < 0.001）和肺栓塞（2.5% vs. 0.4%，p < 0.001）发生率也更高，但出血（11.6% vs. 26.1%，p < 0.001）发生率更低。
与无 COVID-19 的类似手术患者相比，围手术期合并 COVID-19 的患者术后 30 天死亡率和术后并发症发生率更高，尤其是血栓栓塞并发症。这些信息对于这些患者复杂的手术决策和咨询至关重要。
预后和流行病学；IV 级。
