Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: A Dutch, multicenter, matched-cohort clinical study
Pascal Jonker, Willemijn Y. van der Plas, Pieter J. Steinkamp, Ralph Poelstra, Marloes Emous, W van der Meij, Floris M. Thunnissen, Wouter F.W. Bierman, Michel Struys, Philip R. de Reuver, Jean‐Paul P.M. de Vries, Schelto Kruijff, Djamilla Boerma, Sarah Gerritsen, Wout van der Meij, A.S. van Petersen, Charles T. Stevens, Marc R.H.M. van Sambeek, Marleen Hölscher, Apollo Pronk, Wouter J. Bakker, Patrick W. Vriens, Thymen Houwen, Johannes A. Wegdam, T. S. de Vries Reilingh, Ellis E. Schipper, Pascal H.E. Teeuwen, Tessa M. van Ginhoven, Charlotte L. Viëtor, Mark J.W. van der Oest, Sarah Gans, Peter van Duijvendijk, Tanneke Herklots, Tom de Hoop, M De Graaff, Didi Sloothaak, Marieke J Bolster-van Eenennaam, Jedidja Baaij, Maarten Vermaas, Kelly R. Voigt, Gijs A Patijn, Amarins TA. Bransma, Wouter K. G. Leclercq, Julie Sijmons, Martine Uittenbogaart, Paul M. Verheijen, Thijs A. Burghgraef, Marloes Emous, Ralph Poelstra, Manon Teunissen, Herman Frima, Said Bachiri, Lennaert C. B. Groen, Philip R. de Reuver, Floris M. Thunissen, Britt AM. Vermeulen, Anna Groen, Ramon RJP. van Eekeren, Ernst Jan Spillenaar Bilgen, Niels J. Harlaar, F.H.W. Jonker, Sjirk W. van der Burg, L Posma-Bouman, Steven J. Oosterling, Josephine Franken, David R Nellensteijn, Elena Argia Bianca Bensi, Wim van den Broek, Eduard R. Hendriks, Anna AW. van Geloven, Schelto Kruijff, Jean‐Paul P.M. de Vries, Pieter J. Steinkamp, Pascal Jonker, Willemijn Y. van der Plas, Wouter F.W. Bierman, Michel Struys, Yester F. Janssen, Gooitzen M. van Dam, Frank F. A. IJpma, Claire van der Riet, Eline A. Feitsma, F. Kirsten, Simone F. Kleiss, Milan C. Richir, Menno R. Vriens, Mando D. Filipe, Frank C. den Boer, Nicole Dekker, Tim Verhagen, Floor M. ter Brugge, E. A. G. L. Lagae, Evert-Jan G. Boerma, D.G. Schweitzer, Mark H.F. Keulen, Shirley Ketting
Abstract
BACKGROUND: A direct comparison of severe acute respiratory syndrome coronavirus 2 positive patients with a severe acute respiratory syndrome coronavirus 2 negative control group undergoing an operative intervention during the current pandemic is lacking, and a reliable estimate of the assumed difference in morbidity and mortality between both patient categories remains unknown. METHODS: We included all consecutive patients with a confirmed pre- or postoperative severe acute respiratory syndrome coronavirus 2 positive status (operated in 27 hospitals) and negative control patients (operated in 4 hospitals) undergoing emergency or elective operations. A propensity score-matched comparison of clinical outcomes was performed between severe acute respiratory syndrome coronavirus 2 positive and negative tested patients (control group). Primary outcome was overall 30-day mortality rate between both groups. Main secondary outcomes were overall, pulmonary, and thromboembolic complications. RESULTS: In total, 161 severe acute respiratory syndrome coronavirus 2 positive and 342 control severe acute respiratory syndrome coronavirus 2 negative patients were included in this study. The 30-day overall postoperative mortality rate was greater in the severe acute respiratory syndrome coronavirus 2 positive cohort compared with the negative control group (16% vs 4% respectively; P = .007). After propensity score matching, the severe acute respiratory syndrome coronavirus 2 positive group consisted of 123 patients (median 70 years of age [interquartile range 59-77] and 55% male) were compared with 196 patients in the matched control group (median 69 years (interquartile range 58-75] and 53% male). The 30-day mortality rate and risk were greater in the severe acute respiratory syndrome coronavirus 2 positive group compared with the matched control group (12% vs 4%; P = .009 and odds ratio 3.4 [95% confidence interval 1.5-8.5]; P = .005, respectively). Overall, pulmonary and thromboembolic complications occurred more often in severe acute respiratory syndrome coronavirus 2 positive patients (P < .01). CONCLUSION: Patients diagnosed with perioperative severe acute respiratory syndrome coronavirus 2 have an increased risk of 30-day mortality, pulmonary complications, and thromboembolic events. These findings serve as an evidence-based argument to postpone elective surgery and selected emergency cases.