Increased Risk of Postoperative Mortality Associated With Prior COVID-19 Infection.

INTRODUCTION: The impact of COVID-19 infection on surgical patients is largely described by small-cohort studies. This study characterized the risk factors for postoperative mortality among patients with preoperative COVID-19 infection. METHODS: Data were abstracted from the electronic medical record for patients who tested positive for COVID-19 before surgery, excluding procedures related to extracorporeal membrane oxygenation (case, March 2020-April 2021). Mortality was compared with that for patients from the American College of Surgeons National Surgical Quality Improvement Program database (control, January 2018‒February 2020) with chi-square, t test, and multivariable regression. RESULTS: There were 5,209 patients in the control cohort. Among 1,072 patients with positive COVID-19 testing before surgery, 589 had surgeries with specialties tracked by the American College of Surgeons National Surgical Quality Improvement Program (General Surgery, Gynecology, Neurosurgery, Orthopedics, Thoracic, Vascular). Patients with previous COVID-19 infection were younger (age 48 vs 59 years, p<0.001), were more likely to be Black (42% vs 28%, p<0.001), and underwent fewer elective surgeries (55% vs 83%, p<0.001). Postoperative mortality was greater among the case cohort (4.4% vs 1%, p<0.001). On multivariable logistic regression, postoperative mortality increased with age (OR=1.02), emergent surgeries (OR=2.6), and previous COVID-19 infection (OR=3.8). Among patients with previous COVID-19 infection, postoperative mortality was associated with male sex (OR=2.7), higher American Society of Anesthesiologists Physical Status Classification Score (OR=4.8), and smoking history (OR=3.7). CONCLUSIONS: Although data abstraction was limited by the electronic medical record, postoperative mortality is nearly 6 times higher for patients infected with COVID-19 within 2 weeks before surgery when adjusting for patient- and procedure-level factors. Among those with previous COVID-19 infection, postoperative mortality is associated with male sex, American Society of Anesthesiologists Physical Status Classification Score, and smoking history.

Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department.

BACKGROUND: Emergency departments (EDs) are high-yield sites for hepatitis C virus (HCV) screening, but data regarding linkage to care (LTC) determinants are limited. METHODS: Between September 2013 and June 2014, 4371 baby boomers unaware of their HCV status presented to the University of Alabama at Birmingham ED and underwent opt-out screening. A linkage coordinator facilitated referrals for positive cases. Demographic data, International Classification of Diseases, Ninth Revision codes, and clinic visits were collected, and patients were (retrospectively) followed up until February 2015. Linkage to care was defined as an HCV clinic visit within the hospital system. RESULTS: Overall, 332 baby boomers had reactive HCV antibody and detectable plasma ribonucleic acid. The mean age was 57.3 years (standard deviation = 4.8); 70% were male and 61% were African Americans. Substance abuse (37%) and psychiatric diagnoses (30%) were prevalent; 9% were identified with cirrhosis. During a median follow-up of 433 days (interquartile range, 354-500), 117 (35%) linked to care and 48% needed inpatient care. In multivariable analysis, the odds of LTC failure were significantly higher for white males (adjusted odds ratio [aOR], 2.57; 95% confidence interval [CI], 1.03-6.38) and uninsured individuals (aOR, 5.16; 95% CI, 1.43-18.63) and lower for patients with cirrhosis (aOR, 0.36; 95% CI, 0.14-0.92) and access to primary care (aOR, 0.20; 95% CI, 0.10-0.41). CONCLUSIONS: In this cohort of baby boomers with newly diagnosed HCV in the ED, only 1 in 3 were linked to HCV care. Although awareness of HCV diagnosis remains important, intensive strategies to improve LTC and access to curative therapy for diagnosed individuals are needed.