Risk Based Decision Algorithms for Management of COVID-19 Associated Rhino-orbital Mucormycosis

Gupta, Neeti Kapre; Kapre, Madan; Gupta, Harshkaran; Vaidya, Gauri Kapre; Jani, Shripal; Meshram, Sonal; Singh, Sanjog; Kapre, Vidula; Ravi, R.; Tambe, Vilas; Thakkar, Nirmala; Mundhada, Anju

INTRODUCTION: COVID associated mucormycosis is a challenging problem with significant morbidity and mortality implications. COVID affliction, pre-existing medical conditions especially diabetes and steroid prescription are supposed contributors for development of this opportunistic fungal infection. Surgery remains the mainstay of treatment with adequate post-op anti-fungal therapy. MATERIALS AND METHODS: This is a retrospective analysis of prospectively maintained database of all surgical patients between March–May 2021 at a single centre. Prognosticators such as severity of COVID affliction, use of steroids, extent of rhino-orbital mucormycosis, extent of surgery and outcomes were studied. Descriptive statistics was used to analyse frequency of different variables and chi square test was used to analyse prognostic factors. P value < 0.05 were deemed significant. RESULTS: 74 patients with an average 30 day follow-up were included. All patients had preceding COVID infection and 71.6% were diabetic and 25.7% were diagnosed during the course of their COVID treatment. Multiple sinus involvement being most common (52.61%), 10.81% underwent orbital exenteration and 24.32% palatectomies were performed. Revision surgeries were warranted in 16.21% patients. 9 patients succumbed to disease/ underlying medical and treatment related complications. CONCLUSION: We propose a risk assessment based on general condition of patient and severity of mucormycosis infection to decide appropriate strategy for surgical intervention. Early detection and timely and adequate surgery are essential pre-requisites to good outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-021-02692-9.