Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications and thromboembolic events: a Dutch multicenter matched-cohort clinical study

Jonker, Pascal KC.; van der Plas, Willemijn Y.; Steinkamp, Pieter J.; Poelstra, Ralph; Emous, Marloes; van der Meij, Wout; Thunnissen, Floris; Bierman, Wouter FW.; Struys, Michel MRF.; de Reuver, Philip R.; de Vries, Jean-Paul PM.; Kruijff, Schelto

BACKGROUND: A direct comparison of SARS-CoV-2 positive patients with a SARS-CoV-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 SARS-CoV-2 positive status (operated in 27 hospitals) and negative controls (operated in 4 hospitals) undergoing emergency or elective operations. A propensity score-matched comparison of clinical outcomes was performed between SARS-CoV-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 SARS-CoV-2 positive and 342 control SARS-CoV-2 negative patients were included in this study. The 30-day overall postoperative mortality rate was greater in the SARS-CoV-2 positive cohort compared to the negative control group (16% vs. 4% respectively; p=0.007). After propensity score-matching, the SARS-CoV-2 positive group consisted of 123 patients (median 70 years of age [IQR 59-77] and 55% male) were compared to 196 patients in the matched control group (median 69 years (IQR 58 – 75] and 53% male). The 30-day mortality rate and risk were greater in the SARS-CoV-2 positive group compared to the matched control group (12% versus 4%, p=0.009 and OR 3.4 [95%CI 1.5 – 8.5], p=0.005, respectively) . Overall, pulmonary and thromboembolic complications occurred more often in SARS-CoV-2 positive patients (p<0.01). CONCLUSIONS: Patients diagnosed with perioperative SARS-CoV-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.