Key result
Higher SOFA score is linked to ~50% increased 30-day mortality per point in COVID-19 surgical patients.
Why the study?
Risk assessment with prognostic scoring is important but scarcely studied in emergency surgical patients with COVID-19 infection.
Do prognostic scores accurately predict 30-day postoperative mortality in adult emergency surgical patients with COVID-19?
Cohort (n=67)
No
Do prognostic scores accurately predict 30-day postoperative mortality in adult emergency surgical patients with COVID-19?
Hazard Ratio: 1.5
SOFA, POSSUM, and P-POSSUM scores are effective in predicting 30-day postoperative mortality in COVID-19 patients undergoing emergency surgery, with SOFA showing the highest sensitivity.
May support SOFA for mortality prediction in COVID-19 emergency surgery; leaves open prospective validation before routine use.
Background: : Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection. Methods and Material: We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model. Results: Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively). Conclusions: SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.
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Karna et al. (2022) conducted a cohort in COVID-19 infection in emergency surgical patients (n=67). Prognostic scores (SOFA, POSSUM, P-POSSUM, qSOFA, ASA-PS) vs. Lower prognostic scores was evaluated on 30-day postoperative mortality (HR 1.50). Among emergency surgical patients with COVID-19, every unit increase in SOFA score was associated with a 50% higher risk of 30-day mortality, demonstrating good discrimination (AUC 0.88).
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