Background: Intense inflammatory response and the releasing of cytokines are one of the known inflammatory responses in COVID19. Activation of inflammatory cascade increases the production of cytokines and chemokines such as IL-1, IL-6, IL-8, which can increase the risk of the perioperative complication rate.1,2,3 Therefore, we hypothesized that the intense inflammatory response due to COVID19 may delay the recovery process and therefore, adversely impact the outcome of the surgery. A recent study has shown that patients who tested positive for COVID19 and underwent surgery had higher complication rate.4 This study compared the outcomes, duration of hospital stay and complication rates of emergency surgeries between COVID19 and non-COVID19 patients.
Methods: Chart of 117(49 with covid+ and 68 covid-) patients who met the eligibility criteria were reviewed. Data of 117 patients with and without COVID19 diagnosis who underwent emergency surgical procedure at Bronxcare hospital from March 2020 to March 2021 were extracted. Two sample t test and Fisher exact test were performed to analyze and compare the duration of hospital and ICU stay as surgery outcomes and complications between the two groups. Other surgical complications also were identified, and the rates were compared.
Results: Data of 117 patient were analyzed, two patients were excluded from analysis due to prolong stay and preexisting condition. Both groups were similar in age, sex, demographics and comorbid condition. 10 patients with COVID19+ underwent abdominal surgery whereas 53 COVID- patient. 5 COVID19+ and 7 COVID19- patients underwent incision & drainage and debridement under general anesthesia. Remaining patients had vascular, urology, cesarean section and neurosurgical procedures. We compared the duration of hospital and ICU stay among patient who are COVID19+ VS COVID19- confirmed by RT PCR test within 5 days prior to surgery and up to 10 days after surgery. Mean duration of hospital stay among COVID19+ patients with SD as 9.33±9.89 days, whereas COVID19- patient with SD 6.56±9.18 days; (df 115, t – 1.629, P =0.106). Mean ICU stay of COVID19+ with SD as 1.69±4.66, whereas COVID19- patients with SD 0.97±3.57 days;(df 115, t – 0.951, P =0.344). Mean ASA score of COVID19+ with SD as 2.77±0.902, whereas COVID19- patients with SD of 2.37±0.830; (df 104, t – 2.354, P =0.026). 8.2% of the patient with COVID19 had DVT and 28% had COVID pneumonia, whereas 0% in non-COVID patients had DVT or COVID pneumonia (p=0.029). Mean D-dimer, ESR, creatinine, BMI are slightly elevated in COVID whereas WBC, Hemoglobin, lymphocyte, platelets, ferritin, CRP are slightly lower than non-COVID. Two patients in each cohort died within 30 days of surgery
Conclusions: Our data shows that there were no statistically significant differences between duration of hospital and ICU stays between COVID19+ and COVID19- patients who underwent emergency surgery. Rate of DVT was higher in COVID19+ patient (p value=0.029) which is consistent with previous finding4. ASA score was also higher in COVID+ patient (P=0.026). Both are statistically significant; therefore, this finding confirms the need of large study to assess that ASA scoring can be modified based on COVID status of a patient. This provides future direction to conduct large multisite study to discover the role of intra and postoperative anticoagulant among COVID positive patient going for surgery as well as need of redefining ASA scoring.