Letter to the editor regarding ‘clinical characteristics and factors associated with in-hospital post-surgical mortality in COVID-19 patients at a tertiary care center in Karachi, Pakistan

To address comments regarding the study on postoperative outcomes in COVID-19 patients and clarify methodological considerations.

COVID-19 severity classification: The study used proxy indicators for disease severity due to evolving clinical documentation practices and aimed to minimize information bias.
Timing between COVID-19 diagnosis and surgery: Accurate measurement of infection-to-surgery timing was limited; the study focused on real-world outcomes in a low- and middle-income country.
Emergency versus elective surgery: The analysis distinguished between emergency and elective surgeries, finding a lower adjusted hazard of mortality for emergency procedures.
Obstetric and gynecologic procedures: The study did not link maternal and neonatal outcomes due to ethical constraints but found no significant association between obstetric procedures and maternal mortality.
Long COVID and post-acute sequelae: The study did not evaluate long COVID due to inconsistent documentation of persistent symptoms.
Methodological context: The study aimed to fill an evidence gap regarding perioperative outcomes in an LMIC setting, emphasizing strengths despite methodological limitations.

Proxy indicators for COVID-19 severity were used due to evolving documentation practices.
Accurate timing of COVID-19 diagnosis to surgery was not consistently feasible.
Emergency surgeries showed a lower adjusted hazard of mortality after accounting for covariates.
No significant association was found between obstetric procedures and maternal mortality risk.
Long COVID was not assessed due to inconsistent documentation.

The study provides contextually relevant evidence on postoperative outcomes in COVID-19 patients in an LMIC setting.

Future research should focus on maternal and neonatal outcomes and long COVID in surgical patients.