COVID-19 infection associated with poor postoperative outcome 

Researchers found that SARS-CoV-2 infected patients who undergo surgery experience substantially worse postoperative outcomes than would be expected for similar patients who do not have SARS-CoV-2 infection.

Death rates amongst SARS-CoV-2 infected patients approach those of the sickest patients admitted to intensive care units after contracting the virus in the community. 

Researchers examined data from 1,128 patients from 235 hospitals in 24 countries. Results were published in the Lancet.

Overall 30-day mortality in the study was 23.8%. Mortality was disproportionately high across all subgroups, including elective surgery (18.9%), emergency surgery (25.6%), minor surgery such as appendicectomy or hernia repair (16.3%), and major surgery such as hip surgery or colon cancer surgery (26.9%).

The study identified that mortality rates were higher in men (28.4%) versus women (18.2%), and in patients aged 70 years or over (33.7%) versus those aged under 70 years (13.9%). Risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

The study found that overall in the 30 days following surgery 51% of patients developed pneumonia, acute respiratory distress syndrome, or required unexpected ventilation

“We would normally expect mortality for patients having minor or elective surgery to be under 1%, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%). In fact, these mortality rates are greater than those reported for even the highest-risk patients before the pandemic,” said co-author Aneel Bhangu, Senior Lecturer in Surgery at the University of Birmingham.

“We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice. For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed.”

The study found that overall in the 30 days following surgery 51% of patients developed pneumonia, acute respiratory distress syndrome, or required unexpected ventilation. This may explain the high mortality, as most (81.7%) patients who died had experienced pulmonary complications.