Impact of COVID-19 on emergency adult surgical patients, surgical services

Editor's Note

This international multicenter study led by UK researchers finds that the first wave of COVID-19 significantly impacted surgical patients in peak months—directly by comorbid infections and indirectly by increasing mortality, irrespective of COVID-19 status.

In this analysis of 3,176 emergency adult surgical patients from 18 countries (between March and August 2020), all cause in-hospital mortality was 3.6%, compared to 15.5% in-hospital mortality for patients with COVID-19. Only 14.1% were tested for COVID-19 on admission in March, however, increasing to 76.5% by July.

Clinical Frailty Scale score more than 7, American Society of Anesthesiologists (ASA) grade above 2, and COVID-19 infection were independently associated with significantly increased in-hospital mortality from March through May, compared to nonpeak months.

During the study, OR capacity decreased by a mean of 63.6%, along with a 27.3% reduction in OR staff.

Higher frailty scores and ASA grades strongly predicted surgical outcomes and are important risk assessment tools during the COVID-19 pandemic, the authors say.