Clinical characteristics and factors associated with in-hospital post-surgical mortality in COVID-19 patients at a tertiary care center in Karachi, Pakistan

Background: In this study we aimed to determine the clinical manifestations, complications and outcomes of COVID-19 patients who had undergone surgical interventions at a tertiary care hospital in Karachi, Pakistan. Methods: We conducted a retrospective cohort study. Data were extracted from hospital records on all adult COVID-19 patients who had undergone surgical procedures between March 2020 and April 2022. Results: Out of 557 patients, the majority underwent elective procedures (n = 362; 65%). More than half of the procedures were Obstetric or Gynecological Surgery (n = 346; 62%) followed by General Surgery (n = 60; 11%) and Otolaryngology (n = 37; 7%). The cumulative in-hospital mortality was 8%. The most frequent complications were hospital-acquired pneumonia(n = 71; 13%) followed by acute respiratory distress syndrome (ARDS) in (n = 31; 5.6%). Patients undergoing emergency surgery were significantly older (median age 46 vs. 30 years, p < 0.001) with male predominance (58.5% vs. 9.7%, p < 0.001) compared to elective surgery. Increasing age, (HR: 1.03; 95% CI: 1.01–1.05; p = 0.002), pre-existing chronic illnesses including hypertension (HR: 2.03; 95% CI: 1.12–3.71; p = 0.020), chronic kidney disease (HR: 3.07; 95% CI: 1.40–6.75; p = 0.005) and diabetes mellitus (HR: 1.89; 95% CI: 1.04–3.45; p = 0.037) and among complications; myocardial infarction (HR: 2.47; 95% CI: 1.26–4.84; p = 0.009) were significantly associated with an increased hazard for in-hospital death on univariable analysis whereas Conversely, emergency surgical procedure was found to be protective (HR: 0.44; 95% CI: 0.21–0.93; p = 0.030). In the multivariable analysis, emergency surgical procedure status remained a significant protective factor with an adjusted hazard ratio of 0.23 (95% CI: 0.07–0.71; p = 0.010). Conclusion: The risk of post-operative in-hospital mortality was found to be lower in COVID-19 patients who underwent emergency surgical procedures compared with elective surgical procedures. These findings may be due to longer hospitalization in patients who underwent emergency surgical procedures. Larger multicenter studies are needed for a more comprehensive analysis.