Elective surgery during a global health crisis - point incidence of mortality and complications in a Portuguese hospital: A cohort study.

Elective surgeries are often restricted due to pandemics, resource shortages, natural disasters, and mass casualty events, which prioritize emergency care. During the coronavirus disease 2019 pandemic, elective surgeries were significantly affected, with a global estimate of over 20,00,000 cancellations/wk. This retrospective cohort study aims to determine the perioperative mortality rate (POMR) and major morbidity among elective surgical patients admitted to the postanesthetic care unit of a large Portuguese academic medical center during a pandemic wave, evaluating the influence of the national integrated surgical waiting list management system (SIGIC) on these outcomes. The study included 1642 patients admitted to the postanesthetic care unit at Centro Hospitalar Universitário de São João in October and November 2020. Primary outcome was POMR, defined as all-cause death within 30 days post-surgery. Secondary outcomes included postoperative complications, classified by the Clavien-Dindo system. Data were collected retrospectively and analyzed using logistic regression to identify predictors of mortality and major complications. The overall POMR was 0.7%. The 30-day postoperative complication rate was 24.2%, with major complications in 4.9% of patients. Higher ASA scores (III/IV), greater European Society of Anaesthesiology/European Society of Cardiology surgical risk, and plastic surgery were significantly associated with major complications, while weekend surgeries under the SIGIC system were linked to fewer complications. The study's findings highlight that: older patients, males, and those with higher risk scores are more susceptible to major complications. The lower POMR compared to international rates may be due to the study's specific focus on elective noncardiac surgeries. The unique operational adjustments during the coronavirus disease 2019 pandemic, including the use of SIGIC for weekend procedures, contributed to a reduction in major complications.