COVID-19 on Elective Surgery Outcomes in a Brazilian Tertiary Hospital: A Retrospective Cohort Study

BACKGROUND The COVID-19 pandemic significantly disrupted elective surgical services worldwide, especially in resource-limited settings, raising concerns about surgical safety and care quality. This study compared postoperative hospital mortality, day-of-surgery cancellations, and surgical reintervention rates before, during, and after the COVID-19 pandemic among elective surgeries scheduled at a tertiary public hospital in the Federal District, Brazil. MATERIAL AND METHODS This retrospective cohort study included all consecutive adult surgeries scheduled at a tertiary public hospital in the Federal District between January 2018 and December 2022. Trends in hospital mortality, day-of-surgery cancellations, and surgical reintervention rates were evaluated across the pre-pandemic (March 2018-February 2020), lockdown (March 2020-August 2020), and post-lockdown (September 2020-February 2022) periods using the Cochran-Armitage test for trend and multivariate logistic regression analysis. RESULTS Among 8806 scheduled surgeries, 5482 (62.3%) were elective. The number of elective procedures significantly decreased during the lockdown (P<0.001). Day-of-surgery cancellations decreased independently during the lockdown compared with the pre-pandemic period (odds ratio [OR]: 0.556; 95% CI: 0.448-0.691; P<0.001) and showed no significant difference with the post-lockdown period (OR: 0.828; 95% CI: 0.650-1.055; P=0.126). Surgical reintervention rates were unchanged during lockdown (OR: 0.888; 95% CI: 0.662-1.192; P=0.274) but declined significantly in the post-lockdown period (OR: 0.534; 95%CI: 0.390-0.733; P<0.001). No significant differences were found in postoperative hospital mortality across the 3 periods (P=0.847). CONCLUSIONS Reductions in cancellations and reinterventions, without an increase in mortality, were observed in the provision of elective surgical care during the pandemic.