Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures

OBJECTIVE: To evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery SUMMARY BACKGROUND DATA: Although COVID-19 infection is usually associated with mild disease, it can lead to severe respiratory complications Little is known about the perioperative outcomes of patients with COVID-19 METHODS: We examined patients who underwent urgent and emergent surgery at 2 hospitals in New York City from March 17 to April 15, 2020 Elective surgical procedures were cancelled throughout and routine, laboratory based COVID-19 screening was instituted on April 1 Mortality, complications, and admission to the intensive care unit were compared between patients with COVID-19 detected perioperatively and controls RESULTS: Among 468 subjects, 36 (7 7%) had confirmed COVID-19 Among those with COVID-19, 55 6% were detected preoperatively and 44 4% postoperatively Before the routine preoperative COVID-19 laboratory screening, 7 7% of cases were diagnosed preoperatively compared to 65 2% after institution of screening (P = 0 0008) The perioperative mortality rate was 16 7% in those with COVID-19 compared to 1 4% in COVID-19 negative subjects [aRR = 9 29;95% confidence interval (CI), 5 68-15 21] Serious complications were identified in 58 3% of COVID-19 subjects versus 6 0% of controls (aRR = 7 02;95%CI, 4 96-9 92) Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were more common in those with COVID-19 The intensive care unit admission rate was 36 1% in those with COVID-19 compared to 16 4% of controls (aRR = 1 34;95%CI, 0 86-2 09) CONCLUSIONS: COVID-19 is associated with an increased risk for serious perioperative morbidity and mortality A substantial number of patients with COVID-19 are not identified until after surgery