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

• Main Authors: Rehatta, Nancy Margarit, Chandra, Susilo, Sari, Djayanti, Lestari, Mayang Indah, Senapathi, Tjokorda Gde Agung, Nurdin, Haizah, Wirabuana, Belindo, Pramodana, Bintang, Pradhana, Adinda Putra, Isngadi, Isngadi, Anggraeni, Novita, Sikumbang,, Kenanga Marwan, Halimi, Radian Ahmad, Jasa, Zafrullah Khany, Nasution, Akhyar Hamonangan, Mochamat, Mochamat, Purwoko, Purwoko
• Format: Article PeerReviewed
• Language: English
• Published: Elsevier 2022
• Subjects: Medical Virology
• Online Access: https://repository.ugm.ac.id/282298/1/1.pdf; https://repository.ugm.ac.id/282298/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9506116/pdf/jcm-11-05292.pdf
• Institution: Universitas Gadjah Mada

Background: 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. Methods: 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. Results: 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 (p < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04−18.07; p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03−5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96−7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32−5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32−8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p < 0.05. The six comorbidities that have log-rank p < 0.05 are moderate-to-severe renal disease (log-rank p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: 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.