Clinical Outcomes of COVID-19 Positive Patients Who Underwent Surgery: The New York City Experience

Background: The COVID-19 global pandemic has led to a halt in elective surgeries throughout the United States and many other countries throughout the world. Early reports suggest that COVID-19 patients undergoing surgery have an increased risk of requiring intensive care unit (ICU) admission and overall mortality.  Methods: A retrospective review was performed of all COVID-19, positive with PCR confirmation, patients who had surgery between February 17, 2020 and April 26, 2020 at a major New York City hospital. Clinical characteristics and outcomes including ICU admission, ventilator requirement, and mortality were analyzed.  Findings: Thirty-nine COVID-19 surgical patients were identified. Mean age was 53.9 years and there were more males than females in the cohort (56.4% vs 43.6%). Twenty-two patients (56.4%) had a confirmed positive COVID-19 test pre-operatively and the remainder tested positive after their procedure. The majority (59%) of patients had an American Society of Anesthesiologists (ASA) class of 3 or higher. Post-operatively, 7 patients (17.9%) required ICU level care with a mean length of stay of 7.7 days. There were 4 deaths (10.3%) in this patient population, all of which occurred in patients who were ASA Class 3 or 4. Interpretation: This study represents the largest study to date, that objectively analyzes the outcomes of COVID-19 positive patients who underwent surgery. Overall, ICU admission rates and mortality are similar to reported rates in the literature for non-surgical COVID-19 patients. Notably, in COVID-19 patients with ASA 1 or 2, there was a 0% mortality rate in the post-operative period.  Funding Statement: The authors have no funding sources to report. Declaration of Interests: The authors have no financial interest to declare in relation to the content of this work. Ethics Approval Statement: Institutional review board approval (i20-00644).