{"id":818,"date":"2020-06-01T10:13:58","date_gmt":"2020-06-01T04:43:58","guid":{"rendered":"http:\/\/www.potentialloops.org\/?p=818"},"modified":"2020-06-01T10:14:00","modified_gmt":"2020-06-01T04:44:00","slug":"covid-19-patients-who-undergo-surgery-are-at-increased-risk-of-postoperative-death","status":"publish","type":"post","link":"https:\/\/www.potentialloops.org\/?p=818","title":{"rendered":"COVID-19 patients who undergo surgery are at increased risk of postoperative death"},"content":{"rendered":"\n

Date: May 29, 2020 <\/p>\n\n\n\n

Source 1: University of Birmingham <\/p>\n\n\n\n

Source 2: www.sciencedaily.com<\/p>\n\n\n\n

Summary: Patients undergoing surgery after contracting coronavirus are at greatly increased risk of postoperative death, a new global study reveals. Researchers found that amongst SARS-CoV-2 infected patients who underwent surgery, mortality rates approach those of the sickest patients admitted to intensive care after contracting the virus in the community. <\/p>\n\n\n\n

Patients undergoing surgery after contracting\n coronavirus are at greatly increased risk of postoperative death, a new\n global study published in The Lancet<\/em> reveals. Researchers \nfound that amongst SARS-CoV-2 infected patients who underwent surgery, \nmortality rates approach those of the sickest patients admitted to \nintensive care after contracting the virus in the community.<\/p>\n\n\n\n

Researchers examined data for 1,128 patients from 235 hospitals. A \ntotal of 24 countries participated, predominantly in Europe, although \nhospitals in Africa, Asia, and North America also contributed.<\/p>\n\n\n\n

Experts at the University of Birmingham-led NIHR Global Research \nHealth Unit on Global Surgery have now published their findings that \nSARS-CoV-2 infected patients who undergo surgery experience \nsubstantially worse postoperative outcomes than would be expected for \nsimilar patients who do not have SARS-CoV-2 infection.<\/p>\n\n\n\n

Overall 30-day mortality in the study was 23.8%. Mortality was \ndisproportionately high across all subgroups, including elective surgery\n (18.9%), emergency surgery (25.6%), minor surgery such as \nappendicectomy or hernia repair (16.3%), and major surgery such as hip \nsurgery or colon cancer surgery (26.9%).<\/p>\n\n\n\n

The study identified that mortality rates were higher in men (28.4%) \nversus women (18.2%), and in patients aged 70 years or over (33.7%) \nversus those aged under 70 years (13.9%). In addition to age and sex, \nrisk factors for postoperative death included having severe pre-existing\n medical problems, undergoing cancer surgery, undergoing major \nprocedures, and undergoing emergency surgery.<\/p>\n\n\n\n

Report co-author Aneel Bhangu, Senior Lecturer in Surgery at the \nUniversity of Birmingham, commented: “We would normally expect mortality\n for patients having minor or elective surgery to be under 1%, but our \nstudy suggests that in SARS-CoV-2 patients these mortality rates are \nmuch higher in both minor surgery (16.3%) and elective surgery (18.9%). \nIn fact, these mortality rates are greater than those reported for even \nthe highest-risk patients before the pandemic; for example, the 2019 UK \nNational Emergency Laparotomy Audit reported 30-day mortality of 16.9% \nin the highest-risk patients, and a previous study across 58 countries \nreported a 30-day mortality of 14.9% in patients undergoing high-risk \nemergency surgery.”<\/p>\n\n\n\n

“We recommend that thresholds for surgery during the SARS-CoV-2 \npandemic should be raised compared to normal practice. For example, men \naged 70 years and over undergoing emergency surgery are at particularly \nhigh risk of mortality, so these patients may benefit from their \nprocedures being postponed.”<\/p>\n\n\n\n

Patients undergoing surgery are a vulnerable group at risk of \nSARS-CoV-2 exposure in hospital. They may be particularly susceptible to\n subsequent pulmonary complications, due to inflammatory and \nimmunosuppressive responses to surgery and mechanical ventilation. The \nstudy found that overall in the 30 days following surgery 51% of \npatients developed a pneumonia, acute respiratory distress syndrome, or \nrequired unexpected ventilation. This may explain the high mortality, as\n most (81.7%) patients who died had experienced pulmonary complications.<\/p>\n\n\n\n

Report co-author Dmitri Nepogodiev, Research Fellow at the University\n of Birmingham commented: “Worldwide an estimated 28.4 million elective \noperations were cancelled due to disruption caused by COVID-19. Our data\n suggests that it was the right decision to postpone operations at a \ntime when patients were at risk of being infected with SARS-CoV-2 in \nhospital. There’s now an urgent need for investment by governments and \nhealth providers in to measures to ensure that as surgery restarts \npatient safety is prioritised. This includes provision of adequate \npersonal protective equipment (PPE), establishment of pathways for rapid\n preoperative SARS-CoV-2 testing, and consideration of the role of \ndedicated ‘cold’ surgical centres.”<\/p>\n\n\n\n

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Story Source:<\/strong><\/p>\n\n\n\n

Materials<\/a> provided by University of Birmingham<\/strong><\/a>. Note: Content may be edited for style and length.<\/em><\/p>\n\n\n\n

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Journal References<\/strong>:<\/p>\n\n\n\n

  1. COVIDSurg Collaborative. Mortality and pulmonary \ncomplications in patients undergoing surgery with perioperative \nSARS-CoV-2 infection: an international cohort study<\/strong>. The Lancet<\/em>, 2020; DOI: 10.1016\/S0140-6736(20)31182-X<\/a>\n<\/li>
  2. Paul S Myles, Salome Maswime. Mitigating the risks of surgery during the COVID-19 pandemic<\/strong>. The Lancet<\/em>, 2020; DOI: 10.1016\/S0140-6736(20)31256-3<\/a>\n<\/li><\/ol>\n\n\n\n
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