Unscreened: Urgent and Emergent Surgical Outcomes in the Early COVID-19 Pandemic

Abstract

Background Creating useful recommendations for changes in surgical protocols during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult due to a lack of studies based on representative samples. This study evaluates the clinical outcomes and characteristics of patients undergoing urgent or emergent surgeries. Methods This is a multi-center (eight-hospital), retrospective, observational study of urgent and emergent surgical patients from Colorado and Kansas, the United States, in the early stages of the SARS-CoV-2 pandemic. Patient groups were divided based on their coronavirus disease 2019 (COVID-19) status: positive, negative and untested. COVID-19 testing was performed after the surgery if patients were symptomatic. Results The analysis includes 5,547 patients who underwent surgery from March 1, 2020 to May 17, 2020. Seventy-four percent (4,096) were not tested for COVID-19 due to lack of symptoms. Out of the 1,451 tested patients, 1,412 tested negative, and 39 tested positive. Out of all the patients who tested positive, 69.23% were admitted to the intensive care unit (ICU), whereas 16.72% of untested and 21.25% of the negative patients. The invasive ventilation rate for the patients that tested positive was 46.15%, 4.22% for untested, and 8.85% for patients who tested negative. The mortality rate in the positive group was 7.69%, 1.10% in the untested group, and 1.56% in the positive group.    Conclusion Patients who tested positive for COVID-19 had worse clinical outcomes than patients who tested negative and untested. We recommend creating criteria for testing based on patient characteristics and surgical procedure rather than testing all patients awaiting surgery; this would allow us to conserve resources moving forward.