Реферат
Background Managing COVID-19-positive patients requiring surgery is complex due to perceived heightened perioperative risks. However, Canadian data in this context remains scarce. To address this gap, we conducted a multicenter cohort study in the province of Québec, the Canadian province most affected during the initial waves of the pandemic, to comprehensively assess the impact of COVID-19 symptoms, and recovery time, on postoperative outcomes in surgical patients. Methods We included adult surgical patients with either active COVID-19 at time of surgery or those who had recovered from the disease, from March 13, 2020, to April 30, 2021. We evaluated the association between symptoms or recovery time and postoperative pulmonary complications and hospital mortality using multivariable logistic regression and Cox models. Results We included 105 patients with an active infection (47 were symptomatic and 58 were asymptomatic) and 206 who had healed from COVID-19 in seven hospitals. Among patients with an active infection, those who were symptomatic had a higher risk of pulmonary complications (odds ratio = 3.19; 95% CI, from 1.12 to 9.68; p = 0.03) and hospital mortality (hazard ratio = 3.67; 95% CI, from 1.19 to 11.32; p = 0.02). We did not observe any significant effect of the duration of recovery prior to surgery on patients who had healed from their infection. Their postoperative outcomes were also similar to those observed in asymptomatic patients. Interpretation Symptomatic status should be considered in the decision to proceed with surgery in COVID-19-positive patients. Our results may help optimize surgical care in this patient population. Trial registration: ClinicalTrials.gov Identifier: NCT04458337, Registration Date: July 7, 2020.
Тема - темы
COVID-19 , Lung Diseases , Postoperative ComplicationsРеферат
Background: Data on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who undergone a surgery and the pandemic impact on surgical activities. Methods: We conducted a multicenter cohort study between March 13 and June 19 2020. We included COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and overall surgical activities performed in participating centres. Our primary outcome was 30-day mortality. Results: We included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was 15.9%. This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22 616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44 486 cases). Conclusion: In this study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was 15.9%. Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important. Trial registration ClinicalTrials.gov Identifier: NCT04458337