Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Ann Surg Oncol. 2024 Jun;31(6):3639-3648. doi: 10.1245/s10434-024-15152-9. Epub 2024 Mar 26.
The impact of coronavirus disease 2019 (COVID-19) on postoperative recovery from oncology surgeries should be understood for the clinical decision-making. Therefore, this study was designed to evaluate the postoperative cumulative 28-day mortality and the morbidity of surgical oncology patients during the COVID-19 pandemic.
This retrospective cohort study included patients consecutively admitted to intensive care units (ICU) of three centres for postoperative care of oncologic surgeries between March to June 2019 (first phase) and March to June 2020 (second phase). The primary outcome was cumulative 28-day postoperative mortality. Secondary outcomes were postoperative organic dysfunction and the incidence of clinical complications. Because of the possibility of imbalance between groups, adjusted analyses were performed: Cox proportional hazards model (primary outcome) and multiple logistic regression model (secondary outcomes).
After screening 328 patients, 291 were included. The proportional hazard of cumulative 28-day mortality was higher in the second phase than that in the first phase in the Cox model, with the adjusted hazard ratio of 4.35 (95% confidence interval [CI] 2.15-8.82). The adjusted incidences of respiratory complications (odds ratio [OR] 5.35; 95% CI 1.42-20.11) and pulmonary infections (OR 1.53; 95% CI 1.08-2.17) were higher in the second phase. However, the adjusted incidence of other infections was lower in the second phase (OR 0.78; 95% CI 0.67-0.91).
Surgical oncology patients who underwent postoperative care in the intensive care unit during the COVID-19 pandemic had higher hazard of 28-day mortality. Furthermore, these patients had higher odds of respiratory complications and pulmonary infections. Trials registration The study is registered in the Brazilian Registry of Clinical Trials under the code RBR-8ygjpqm, UTN code U1111-1293-5414.
了解 2019 年冠状病毒病（COVID-19）对肿瘤手术后康复的影响对于临床决策至关重要。因此，本研究旨在评估 COVID-19 大流行期间肿瘤外科手术后 28 天的累积死亡率和手术患者的发病率。
本回顾性队列研究纳入了 2019 年 3 月至 6 月（第一阶段）和 2020 年 3 月至 6 月（第二阶段）期间连续入住三个中心重症监护病房（ICU）接受肿瘤外科术后护理的患者。主要结局是 28 天术后累积死亡率。次要结局为术后器官功能障碍和临床并发症的发生率。由于两组之间存在失衡的可能性，因此进行了调整分析：Cox 比例风险模型（主要结局）和多因素逻辑回归模型（次要结局）。
经过筛选 328 例患者，纳入 291 例。Cox 模型中，第二阶段累积 28 天死亡率的比例风险高于第一阶段，调整后的风险比为 4.35（95%置信区间[CI] 2.15-8.82）。第二阶段的呼吸系统并发症（比值比[OR] 5.35；95% CI 1.42-20.11）和肺部感染（OR 1.53；95% CI 1.08-2.17）的调整发生率较高。然而，第二阶段其他感染的调整发生率较低（OR 0.78；95% CI 0.67-0.91）。
COVID-19 大流行期间在重症监护病房接受术后护理的肿瘤外科患者 28 天死亡率的风险更高。此外，这些患者发生呼吸系统并发症和肺部感染的几率更高。试验注册本研究在巴西临床试验注册处注册，注册号为 RBR-8ygjpqm，UTN 编号为 U1111-1293-5414。
