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COVID-19 on Elective Surgery Outcomes in a Brazilian Tertiary Hospital: A Retrospective Cohort Study
Dilson Palhares Ferreira1,2, Cláudia Vicari Bolognani3, Luana Argollo Souza Fernandes2
1Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, DF, Brazil.
Insights
The COVID-19 pandemic saw fewer elective surgeries, but cancellations and reinterventions decreased without increasing patient mortality. This study analyzed surgical outcomes during the pandemic in Brazil.
Area of Science:
- Public Health
- Surgical Outcomes
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted global elective surgical services, particularly in resource-limited areas.
- Concerns arose regarding surgical safety and the quality of care provided during this period.
- This study investigated the impact of the pandemic on elective surgeries in Brazil.
Purpose of the Study:
- To compare postoperative hospital mortality, day-of-surgery cancellations, and surgical reintervention rates.
- To evaluate these rates before, during, and after the COVID-19 pandemic.
- To assess the safety and quality of elective surgical care during the pandemic.
Main Methods:
- A retrospective cohort study of adult surgeries at a tertiary public hospital in Brazil (January 2018-December 2022).
- Analysis of elective surgeries across pre-pandemic, lockdown, and post-lockdown periods.
- Statistical evaluation using the Cochran-Armitage test for trend and multivariate logistic regression.
Main Results:
- Elective procedures decreased during the lockdown period (P<0.001).
- Day-of-surgery cancellations decreased significantly during lockdown (OR: 0.556; P<0.001) and remained stable post-lockdown.
- Surgical reintervention rates declined significantly in the post-lockdown period (OR: 0.534; P<0.001), with no change during lockdown.
- Postoperative hospital mortality showed no significant differences across the study periods (P=0.847).
Conclusions:
- Elective surgical care during the COVID-19 pandemic was associated with reduced cancellations and reinterventions.
- These improvements occurred without a significant increase in postoperative hospital mortality.
- The findings suggest that surgical services adapted effectively to pandemic-related challenges.
Abstract:
BACKGROUND The COVID-19 pandemic significantly disrupted elective surgical services worldwide, especially in resource-limited settings, raising concerns about surgical safety and care quality. This study compared postoperative hospital mortality, day-of-surgery cancellations, and surgical reintervention rates before, during, and after the COVID-19 pandemic among elective surgeries scheduled at a tertiary public hospital in the Federal District, Brazil. MATERIAL AND METHODS This retrospective cohort study included all consecutive adult surgeries scheduled at a tertiary public hospital in the Federal District between January 2018 and December 2022. Trends in hospital mortality, day-of-surgery cancellations, and surgical reintervention rates were evaluated across the pre-pandemic (March 2018-February 2020), lockdown (March 2020-August 2020), and post-lockdown (September 2020-February 2022) periods using the Cochran-Armitage test for trend and multivariate logistic regression analysis. RESULTS Among 8806 scheduled surgeries, 5482 (62.3%) were elective. The number of elective procedures significantly decreased during the lockdown (P<0.001). Day-of-surgery cancellations decreased independently during the lockdown compared with the pre-pandemic period (odds ratio [OR]: 0.556; 95% CI: 0.448-0.691; P<0.001) and showed no significant difference with the post-lockdown period (OR: 0.828; 95% CI: 0.650-1.055; P=0.126). Surgical reintervention rates were unchanged during lockdown (OR: 0.888; 95% CI: 0.662-1.192; P=0.274) but declined significantly in the post-lockdown period (OR: 0.534; 95%CI: 0.390-0.733; P<0.001). No significant differences were found in postoperative hospital mortality across the 3 periods (P=0.847). CONCLUSIONS Reductions in cancellations and reinterventions, without an increase in mortality, were observed in the provision of elective surgical care during the pandemic.
