Morbidity and mortality after elective cancer surgery-How does recent Covid-19 infection impact outcome: A prospective, comparative study

Background and aims: Post-Covid-19 cancer patients are likely to have poor postoperative outcomes following cancer surgeries. This is mainly because of the coexisting risk factors unique to cancer patients like immunosuppression, chemotherapy, and radiotherapy-induced risk of infection and malnutrition. The purpose of this study was to compare the postoperative morbidity in cancer patients with and without a history of Covid infection.

Material and methods: This was a prospective observational study. Subjects were divided into post-Covid 19 (PC) and non-Covid 19 (NC) groups based on the history of SARS CoV2. Preoperative data including details of past Covid infection, chemotherapy, radiotherapy, comorbidity index, Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score, and nutritional indices were recorded for patients undergoing elective cancer surgery. Thirty-day postoperative morbidity, mortality was recorded.

Results: Of the total patients (n = 414), 109 had postoperative complications (26.33%), reported to be higher in the PC group (33.87%) than the NC (25%) (P value: 0.19). Pulmonary complications were commonest with higher incidence in PC (25.8%) group (P value: 0.001). It was 40% in 2-4 weeks after Covid 19 diagnosis reducing to 18% and 25% in 4-8 weeks and 8-12 weeks, respectively. The overall mortality rate was 0.72%. P-POSSUM morbidity score was similar between the two groups. (PC: 38.30 ± 19.4; Covid negative 37.8 ± 16.7 P value 0.84). Old age, hypothyroidism, and low Prognostic nutritional index were associated with a higher incidence of complications.

Conclusions: Cancer patients with a history of Covid infection undergoing elective surgery are at a higher risk of postoperative pulmonary complications.