Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: A Dutch, multicenter, matched-cohort clinical study.
Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: A Dutch, multicenter, matched-cohort clinical study.
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DOI：
10.1016/j.surg.2020.09.022
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发表时间：
2021-03
期刊：
影响因子：
3.8
通讯作者：
Dutch Surgical COVID-19 Research Collaborative
中科院分区：
文献类型：
--
作者：
Jonker PKC;van der Plas WY;Steinkamp PJ;Poelstra R;Emous M;van der Meij W;Thunnissen F;Bierman WFW;Struys MMRF;de Reuver PR;de Vries JPM;Kruijff S;Dutch Surgical COVID-19 Research Collaborative
缺乏对当前大流行期间接受手术干预的严重急性呼吸综合征冠状病毒2阳性患者与严重急性呼吸综合征冠状病毒2阴性对照组的直接比较，并且对两类患者之间假设的发病率和死亡率差异的可靠估计仍然未知。我们纳入了所有连续接受急诊或择期手术的术前或术后严重急性呼吸综合征冠状病毒2呈阳性的患者（在27家医院进行过手术）和阴性对照患者（在4家医院进行过手术）。对严重急性呼吸综合征冠状病毒2阳性和阴性测试患者（对照组）的临床结果进行倾向评分匹配比较。主要结局是两组之间的 30 天总体死亡率。主要次要结局是总体并发症、肺部并发症和血栓栓塞并发症。本研究总共纳入了 161 名严重急性呼吸综合征冠状病毒 2 阳性患者和 342 名对照严重急性呼吸综合征冠状病毒 2 阴性患者。与阴性对照组相比，严重急性呼吸综合征冠状病毒 2 阳性组的 30 天总体术后死亡率更高（分别为 16% 和 4%；P = .007）。经过倾向评分匹配后，严重急性呼吸综合征冠状病毒2阳性组由123名患者组成（中位年龄70岁[四分位距59-77]，55%男性），与匹配对照组的196名患者（中位年龄69岁（四分位距58-75]，53%男性）相比。严重急性呼吸综合征冠状病毒2阳性组的30天死亡率和风险更高与匹配对照组相比（分别为 12% 和 4%；比值比为 3.4 [95% 置信区间 1.5–8.5]；P = .005）。总体而言，严重急性呼吸综合征冠状病毒 2 阳性患者更常发生肺部和血栓栓塞并发症（P < .01）。被诊断为围手术期严重急性呼吸综合征冠状病毒 2 的患者的 30 天死亡率、肺部并发症和血栓栓塞并发症的风险增加。这些发现为推迟择期手术和选定的紧急病例提供了基于证据的论据。
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. 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. 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). 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.
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