Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Surgical patients (perioperative) (n=114). Intervention: Peri- or post-operative COVID-19 infection vs. Patients who tested negative for COVID-19 (pre-pandemic surgical patients). Primary outcome: 30-day post-operative mortality (OR 5.75, 95% CI 2.075-15.934, p=0.001).

Q: What does this research mean for the field?

Peri- or postoperative SARS-CoV-2 infection significantly increases the risk of postoperative complications and mortality in surgical patients, with pneumonia and emergency surgery serving as key independent risk factors for mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Bengü Óaylan; Bülent BarıÓ Güven; Habip Yılmaz; Óeyma BaÓlılar

doi:10.24875/cirue.m22000503

September 30, 2026Cirugía y Cirujanos (English Edition)Open Access

Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19

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Key result

Perioperative COVID-19 infection linked to ~5.8-fold higher 30-day post-operative mortality.

OR 5.75
95% CI 2.075-15.934
P=0.001
n=114

Why the study?

The effect of COVID-19 infection on postoperative complications and mortality in surgical patients and associated risk factors was not well defined.

Does perioperative COVID-19 infection increase post-operative complications and mortality in surgical patients?

Key Points

To identify and evaluate clinical, laboratory, and surgical factors influencing post-operative complications and mortality in surgical patients with and without COVID-19.
Comparative analysis of surgical patients categorized into a COVID-19 group (n = 38) and an uninfected control group (n = 76).
Evaluated patient demographics, ASA grades, procedural urgency (urgent vs. elective), surgical invasiveness (minor vs. major), and laboratory values including lymphocyte counts, CRP, and D-dimer.
Identified risk factors for complications and post-operative death using univariate and multivariate logistic regression models.
Post-operative mortality was significantly higher in the COVID-19 group than in controls (14/38 [36.8%] vs. 7/76 [9.2%], p = 0.001; univariate OR: 5.75, CI: 2.075-15.934, p = 0.001).
Overall complications occurred more frequently with COVID-19 (20/38 [52.6%] vs. 24/76 [31.6%], p = 0.049; OR: 2.407, CI: 1.082-5.356, p = 0.031), with higher rates of pulmonary complications (16/38 [42.1%] vs. 13/76 [17.1%], p = 0.008) and cardiac complications (13/38 [34.2%] vs. 9/76 [11.8%], p = 0.017).
Multivariate regression revealed D-dimer as an independent predictor of complications (OR: 1.001, CI: 1.000-1.002), while urgent surgery (OR: 9.431, CI: 1.469-60.542) and pneumonia (OR: 15.27, CI: 2.06-113.095) were independent predictors of mortality.

Study Design

Type

Cohort (n=114)

Multicenter

No

Structured PICO

Does perioperative COVID-19 infection increase post-operative complications and mortality in surgical patients?

P

Population

114 adult inpatients who underwent surgical procedures, including 38 with perioperative COVID-19 infection and 76 matched pre-pandemic controls, evaluated for 30-day postoperative outcomes.

E

Exposure

Perioperative COVID-19 infection (positive SARS-CoV-2 PCR test before or within 10 days following surgery)

C

Comparator

No COVID-19 infection (control group operated before the pandemic)

O

Outcome

30-day post-operative mortality and post-operative complicationshard clinical

Main Result

Odds Ratio: 5.75 (95% CI 2.075–15.934)

Absolute Event Rate: 36.8% vs 9.2%

p-value: p=0.001

Limitations

Small sample size as a single-center study
The specific types of surgery performed (e.g., malignant/benign, abdominal, neurosurgery, orthopedic) were not evaluated in detail
The effect of obesity could not be evaluated due to a lack of body mass index data for most patients
Unable to evaluate differences in morbidity and mortality between pre-operative and post-operative PCR positivity due to low patient numbers
Small sample size as it was a single center study
Surgery type was not evaluated in detail (e.g., malignant vs benign, neurosurgery vs orthopedic)
Lack of body mass index data for most patients
Unable to evaluate differences among COVID-19 patients according to the timing of infection (pre- vs post-operative PCR positivity)

Implication

Perioperative COVID-19 infection significantly increases the risk of post-operative complications and mortality, suggesting that emergency surgeries in infected patients should be delayed when appropriate.

Abstract

Objective: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. Methods: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. Results: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. Conclusion: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

Discussion

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Cite This Study

Óaylan et al. (2026) conducted a cohort in Surgical patients (perioperative) (n=114). Peri- or post-operative COVID-19 infection vs. Patients who tested negative for COVID-19 (pre-pandemic surgical patients) was evaluated on 30-day post-operative mortality (OR 5.75, 95% CI 2.075-15.934, p=0.001). Perioperative COVID-19 infection was associated with a significantly increased risk of 30-day post-operative mortality (36.8% vs 9.2%; OR 5.75) compared to uninfected surgical patients.

synapsesocial.com/papers/6ad1156900741cc3fba7d375 https://doi.org/10.24875/cirue.m22000503

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Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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