A retrospective analysis of characteristics and perioperative outcomes of rhino-orbital-cerebral mucormycosis in COVID-19 patients posted for surgical debridement under general anaesthesia in a tertiary care hospital

Abstract

Abstract Background: Rhino-orbital-cerebral mucormycosis (ROCM) has increasingly been reported in patients with severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) disease-2019 (COVID-19) from India. Methods: A retrospective study was done to analyse the demographic and clinical characteristics, treatment received for COVID-19 during the hospital stay, perioperative outcomes in ROCM patients posted for surgical debridement under general anaesthesia from May 2021 to July 2021 at our tertiary care teaching hospital in Tirupati, southern India. Results: Overall, 350 patients with ROCM and COVID-19 had undergone surgical debridement under general anaesthesia Mucormycosis was predominantly seen in males (65.7%). Majority of the cases (40%) were in the age group between 41-50 years. Common comorbidities were: pre-existing diabetes mellitus (DM) (70%), hypertension (32%), new-onset DM/hyperglycaemia (22%) and cardiac disease (8%). The most common sites involved in mucormycosis were the nose and paranasal sinuses (100%) followed by rhino-orbital (63.1%). A history of hospital admission for COVID-19 management was evident in 89.7%; 40.7% of the patients had received oxygen therapy during their hospital stay. The use of corticosteroids for the treatment of COVID-19 was noted in 73.2%. The types of surgical procedures done were: functional endoscopic sinus surgery (FESS) (98.5%) and neurosurgery procedures (3.4%). Revision surgery was performed in 18.5% of the cases. Perioperative complications observed were anticipated difficult intubation during pre-operative airway assessment 35.7%, intraoperative hypertension 8.5%. A patient had developed intraoperative cardiac arrest, post-operative-delayed recovery and needed ventilator requirement. Outcomes of ROCM patients associated with COVID-19 were: discharged 91.7%, death 8.3%. Conclusions: Diabetes mellitus, rampant use of corticosteroids in the treatment of COVID-19 appear to have contributed to the development of ROCM. Early diagnosis, a thorough pre-operative evaluation, surgical debridement are likely to result in better prognosis in COVID-19 patients with ROCM.