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Updated: Nov 1, 2025
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Does Coronavirus Disease 2019 (COVID-19) Affect Perioperative Morbidity and Mortality for Patients Requiring
Mathew Sewell1, Fahid Rasul1, Kathak Vachhani2
1Department of Spinal Surgery, Royal London Hospital, London, United Kingdom.
Insights
COVID-19 did not increase mortality or complications in emergency spinal surgery patients. However, positive cases had longer hospital stays and specific risk factors like smoking and fever increased morbidity.
Area of Science:
- Spinal Surgery
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic significantly impacted global health services, necessitating resource reallocation.
- Emergency instrumented spinal surgeries continued despite the pandemic, but clinical outcomes for COVID-19 patients remained unknown.
- Understanding the perioperative impact of COVID-19 on these vulnerable patients was crucial.
Purpose of the Study:
- To evaluate the effects of COVID-19 on perioperative morbidity and mortality in patients undergoing emergency instrumented spinal surgery.
- To identify specific risk factors associated with increased morbidity and mortality in COVID-19 positive patients undergoing spinal surgery.
Main Methods:
- A retrospective cohort study comparing 8 COVID-19 positive patients with 11 COVID-19 negative patients.
- Patients underwent emergency instrumented spinal surgery at a UK hospital during the pandemic peak.
- Data were collected via case note review, comparing perioperative outcomes within 30 days post-surgery.
Main Results:
- No mortalities were observed in either group; complication rates (50% vs. 55%) and ICU admissions (37.5% vs. 36%) were comparable.
- Respiratory infection was the most common complication in both COVID-19 positive and negative groups.
- COVID-19 positive patients experienced significantly longer hospital stays (19 days vs. 10 days).
Conclusions:
- Emergency instrumented spinal surgery in COVID-19 positive patients resulted in longer hospital stays but not increased mortality or complications.
- Risk factors for increased morbidity in COVID-19 positive patients included smoking, abnormal BMI, preoperative oxygen needs, fever, and low oxygen saturation (<95%).
- These findings highlight the importance of managing specific risk factors in COVID-19 positive patients undergoing emergency spinal surgery.
Background:
The coronavirus disease 2019 (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 to determine risk factors for increased morbidity/mortality.
Methods:
This retrospective cohort study included 11 patients who were negative for COVID-19 and 8 patients who were positive for COVID-19 who underwent emergency instrumented spinal surgery in 1 hospital in the United Kingdom 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), comorbidities, surgical indication, and preoperative neurologic 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 patients positive for COVID-19 (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 patients positive for COVID-19 (37.5%) required intensive care unit 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.
Conclusions:
Emergency instrumented spinal surgery in patients positive for COVID-19 was associated with increased length of hospital stay. There was no difference in occurrence of complications or intensive care unit admission. Risk factors for increased morbidity in patients with COVID-19 included smoking, abnormal BMI, preoperative oxygen requirement, fever and saturations <95%.
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