Does COVID-19 affect perioperative morbidity and mortality for patients requiring emergency instrumented spinal surgery? A single-centre cohort study

Sewell, Mathew; Rasul, Fahid; Vachhani, Kathak; Sedra, Fady; Aftab, Syed; Pushpananthan, Suresh; Bull, Jonathan; Ranganathan, Arun; Montgomery, Alex

Background The COVID-19 pandemic sent shockwaves through health services worldwide. Resources were reallocated. Patients with COVID-19 still required instrumented spinal surgery for emergencies. Clinical outcomes for these patients are not known. The objective of this study was to evaluate the effects of COVID-19 on perioperative morbidity and mortality for patients undergoing emergency instrumented spinal surgery, and determine risk factors for increased morbidity/mortality. Methods This retrospective cohort study included 11 COVID-19 negative, and 8 COVID-19 positive patients who underwent emergency instrumented spinal surgery in one United Kingdom hospital during the pandemic peak. Data collection was performed through case note review. Patients in both treatment groups were comparable for age, sex, body mass index (BMI), co-morbidities, surgical indication and preoperative neurological status. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariable analysis was used to identify risk factors for increased morbidity. Results There were no mortalities in either treatment group. Four COVID-19 positive patients (50%) developed a complication, compared with 6 (55%) in the COVID-19 negative group (p>0.05). The commonest complication in both groups was respiratory infection. Three COVID-19 positive patients (37.5%) required intensive care unit (ICU) admission, compared with 4 (36%) in the COVID-19 negative group (p>0.05). The average time between surgery and discharge was 19 and 10 days in COVID-19 positive and negative groups respectively (p=0.02). In the COVID-19 positive group, smoking, abnormal BMI, preoperative oxygen requirement, presence of fever and oxygen saturations <95% correlated with increased risk of complications. Conclusion Emergency instrumented spinal surgery in COVID-19 positive patients was associated with increased length of hospital stay. There was no difference in occurrence of complications or ICU admission. Risk factors for increased morbidity in patients with COVID-19 included smoking, abnormal BMI, preoperative oxygen requirement, fever and saturations <95%.