{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:05:12Z","timestamp":1762538712654,"version":"build-2065373602"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"45","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT Fundacao para a Ciencia e Tecnologia","award":["UIDB\/4255\/2020"],"award-info":[{"award-number":["UIDB\/4255\/2020"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,7]]},"abstract":"<jats:p>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 Universit\u00e1rio de S\u00e3o Jo\u00e3o 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\u2013Dindo 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\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.1097\/md.0000000000045758","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:02:23Z","timestamp":1762538543000},"page":"e45758","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Elective surgery during a global health crisis \u2013 point incidence of mortality and complications in a Portuguese hospital: A cohort study"],"prefix":"10.1097","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2542-9730","authenticated-orcid":false,"given":"Ana L\u00eddia","family":"Rouxinol-Dias","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"},{"name":"RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9602-4511","authenticated-orcid":false,"given":"Diana","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7629-7643","authenticated-orcid":false,"given":"Leonardo","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7938-1101","authenticated-orcid":false,"given":"Patr\u00edcia Martins","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6124-930X","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9356-3272","authenticated-orcid":false,"given":"Cl\u00e1udia Camila","family":"Dias","sequence":"additional","affiliation":[{"name":"RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal"},{"name":"Knowledge Management Unit, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-4264","authenticated-orcid":false,"given":"Joana","family":"Berger-Estilita","sequence":"additional","affiliation":[{"name":"RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Institute of Anesthesiology and Intensive Care, Salem Spital, Hirslanden Hospital Group, Bern, Switzerland"},{"name":"Institute for Medical Education, University of Bern, Bern, Switzerland."}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5503-051X","authenticated-orcid":false,"given":"Cristina","family":"Granja","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"},{"name":"RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"}]}],"member":"276","reference":[{"key":"R1-20251107","article-title":"Natural Disasters and Elective Medical Services: How Big is the Bounce-Back? (July 2020). NBER Working Paper No. w27505.","author":"Deryugina"},{"key":"R3-20251107","first-page":"1440","article-title":"Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans.","volume":"107","author":"Collaborative","year":"2020","journal-title":"Br J Surg"},{"key":"R4-20251107","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13037-020-00235-9","article-title":"How to risk-stratify elective surgery during the COVID-19 pandemic?","volume":"14","author":"Stahel","year":"2020","journal-title":"Patient Saf Surg"},{"key":"R5-20251107","article-title":"Sustainability and resilience in the portuguese health system.","author":"Oliveira","year":"2022","journal-title":"Partnership Health Syst Sustain Resilience"},{"key":"R6-20251107","doi-asserted-by":"crossref","first-page":"10942","DOI":"10.1038\/s41598-022-13746-5","article-title":"The disruption of elective procedures due to COVID-19 in Brazil in 2020.","volume":"12","author":"Frio","year":"2022","journal-title":"Sci Rep"},{"key":"R7-20251107","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/SLA.0000000000004848","article-title":"Pandemic recovery: persistent disparities in access to elective surgical procedures.","volume":"277","author":"Lin","year":"2023","journal-title":"Ann Surg"},{"key":"R10-20251107","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration.","volume":"4","author":"Vandenbroucke","year":"2007","journal-title":"PLoS Med"},{"key":"R14-20251107","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0140-6736(15)60160-X","article-title":"Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.","volume":"386","author":"Meara","year":"2015","journal-title":"Lancet"},{"key":"R15-20251107","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s00268-020-05804-8","article-title":"The value of reporting perioperative mortality rates (POMR).","volume":"45","author":"Watters","year":"2021","journal-title":"World J Surg"},{"key":"R16-20251107","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"R17-20251107","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience.","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"R18-20251107","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s10353-018-0551-z","article-title":"Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients.","volume":"50","author":"Bolliger","year":"2018","journal-title":"Eur Surg"},{"key":"R19-20251107","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0140-6736(21)00001-5","article-title":"Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries.","volume":"397","year":"2021","journal-title":"Lancet"},{"key":"R20-20251107","doi-asserted-by":"crossref","first-page":"e026646","DOI":"10.1136\/bmjopen-2018-026646","article-title":"Quality and outcomes in global cancer surgery: protocol for a multicentre, international, prospective cohort study (GlobalSurg 3).","volume":"9","year":"2019","journal-title":"BMJ Open"},{"key":"R21-20251107","doi-asserted-by":"crossref","first-page":"122","DOI":"10.21315\/mjms2018.25.4.12","article-title":"Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data.","volume":"25","author":"Bujang","year":"2018","journal-title":"Malays J Med Sci"},{"key":"R22-20251107","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis.","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"},{"key":"R23-20251107","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1472-6963-6-22","article-title":"Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.","volume":"6","author":"Upshur","year":"2006","journal-title":"BMC Health Serv Res"},{"key":"R24-20251107","doi-asserted-by":"crossref","first-page":"e601","DOI":"10.1002\/bjs.12050","article-title":"Delaying surgery for patients with a previous SARS-CoV-2 infection.","volume":"107","year":"2020","journal-title":"Br J Surg"},{"key":"R25-20251107","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/bja\/aew316","article-title":"Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.","volume":"117","year":"2016","journal-title":"Br J Anaesth"},{"key":"R26-20251107","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jclinane.2018.06.025","article-title":"Perioperative mortality related to anesthesia within 48\u2009h and up to 30 days following surgery: a retrospective cohort study of 11,562 anesthetic procedures.","volume":"49","author":"Stefani","year":"2018","journal-title":"J Clin Anesth"},{"key":"R27-20251107","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1016\/j.jvs.2019.03.020","article-title":"Weekend effect among patients undergoing elective vascular surgery.","volume":"70","author":"Galyfos","year":"2019","journal-title":"J Vasc Surg"},{"key":"R29-20251107","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1163\/15718093-12271448","article-title":"Healthcare resource allocation and priority-setting. a European challenge.","volume":"27","author":"Di Costanzo","year":"2020","journal-title":"Eur J Health Law"},{"key":"R30-20251107","first-page":"104395","article-title":"Elective surgeries during and after the COVID-19 pandemic: case burden and physician shortage concerns.","volume":"81","author":"Mehta","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"R31-20251107","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1177\/00031348241227213","article-title":"Impact of COVID-19 pandemic surge on surgical outcomes: a retrospective study.","volume":"90","author":"Yoshida","year":"2024","journal-title":"Am Surg"},{"issue":"Supplement_2","key":"R32-20251107","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/eurpub\/ckad160.810","article-title":"Workers needed: a needed assessment of the workforce in local public health services in Portugal.","volume":"33","author":"Vasconcelos","year":"2023","journal-title":"Eur J Public Health"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000045758","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:02:29Z","timestamp":1762538549000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000045758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":25,"journal-issue":{"issue":"45","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000045758","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]},"assertion":[{"value":"2025-03-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}