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Papers of the Week

2022 Sep 08

J Clin Med



Perioperative Factors Impact on Mortality and Survival Rate of Geriatric Patients Undergoing Surgery in the COVID-19 Pandemic: A Prospective Cohort Study in Indonesia.


Rehatta N M, Chandra S, Sari D, Lestari M I, Senapathi T G A, Nurdin H, Wirabuana B, Pramodana B, Pradhana A P, Isngadi I, Anggraeni N, Sikumbang K M, Halimi R A, Jasa Z K, Nasution A H, Mochamat M, Purwoko P
J Clin Med. 2022 Sep 08; 11(18).
PMID: 36142942.


The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan-Meier survival analysis. We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality ( < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04-18.07; = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03-5.26; = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96-7.00; ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32-5.53; = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32-8.96; = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank < 0.05. The six comorbidities that have log-rank < 0.05 are moderate-to-severe renal disease (log-rank ≤ 0.01), cerebrovascular disease (log-rank ≤ 0.01), diabetes with chronic complications (log-rank = 0.03), metastatic solid tumor (log-rank = 0.02), dementia (log-rank ≤ 0.01), and rheumatology disease (log-rank = 0.03). Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic.