• Anne Knisely, Zhen Ni Zhou, Jenny Wu, Yongmei Huang, Kevin Holcomb, Alexander Melamed, Arnold P Advincula, Anil Lalwani, Fady Khoury-Collado, Ana I Tergas, Caryn M St Clair, June Y Hou, Dawn L Hershman, Mary E D'Alton, Yolanda Ya-Chin Huang, and Jason D Wright.
• Columbia University Vagelos College of Physicians and Surgeons, New York City, New York.
• Ann. Surg. 2021 Jan 1; 273 (1): 34-40.

ObjectiveTo evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery.Summary Background DataAlthough 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.MethodsWe 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.ResultsAmong 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).ConclusionsCOVID-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.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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