Summary

A nomogram to predict 30-day morbidity and mortality in COVID-19

Abstract

Introduction

Minimising postoperative complications and mortality in COVID-19 patients undergoing trauma and orthopaedic surgeries is an international priority. Thus, the study aimed primarily to develop a predictive nomogram for 30-day morbidity/mortality of COVID-19 infection in patients who underwent orthopaedic and trauma surgery during the coronavirus pandemic in the UK in 2020. Our secondary objective was to compare patients with positive and negative PCR tests regarding perioperative characteristics.

Methods

A retrospective multicentre study was conducted in 36 hospitals in England, Wales, Scotland, and Ireland. Patients with suspicion of SARS-CoV-2 infection who had undergone orthopaedic or trauma (bony or soft tissue procedure) surgery for any indication during the 2020 pandemic were enrolled in the study (n =2525 patients). Multivariable logistic regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed from the logistic regression model.

Results

Overall, 658 patients had a negative preoperative test, 151 had a positive test and 1716 had an unknown preoperative COVID-19 status. The following variables were independent predictors of 30-day complications/mortality: Preoperative COVID-19 status, sex, ASA grade, urgency and indication of surgery, use of tourniquet, grade of the operating surgeon and comorbidities (like diabetes, and cardiovascular, renal, pulmonary and cognitive diseases).

Conclusions

Orthopaedic and trauma surgeons can use nomograms developed in this study as a practical and effective tool in postoperative complications and mortality risk estimation. So that with early diagnosis and intervention, postoperative morbidity and mortality in COVID-19 patients may be reduced.