Patients with COVID-19 who undergo surgery are at increased risk of postoperative mortality and pulmonary complications, a new global study published in The Lancet reveals.
Western University Associate Professor Janet Martin is part of the CovidSurg Collaborative which examined data for 1,128 patients from 235 hospitals in 24 countries, including Europe Africa, Asia, and North America.
In collaboration with lead researchers at the University of Birmingham, the research findings show that COVID-19 patients who undergo surgery experience substantially worse postoperative outcomes than would be expected for similar patients who do not have COVID-19.
Overall 30-day mortality for COVID-19 patients who underwent surgery was almost one in four, or 23.8 per cent. Mortality was disproportionately higher than expected across all subgroups, including elective surgery (18.9 per cent), emergency surgery (25.6 per cent), minor surgery such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or colon cancer surgery (26.9 per cent). The study also found that 51 per cent of patients developed pulmonary complications within 30 days after surgery.
“As elective surgeries begin to resume here and elsewhere around the globe, this study will help to guide decision-making for surgery. We now understand the risk of mortality by age, and sex, as well as emergency versus elective status,” said Martin, Associate Professor at Western’s Schulich School of Medicine & Dentistry. “Our goal is to achieve optimal patient outcomes. For the first time, we have data from a large study to inform when the benefits from surgery outweigh the risks in patients who may also have COVID-19. This is timely given our need to re-open elective surgery safely during a global pandemic.”
The study identified that mortality rates were higher in men (28.4 per cent) versus women (18.2 per cent), and in patients aged 70 years or over (33.7 per cent) versus those aged under 70 years (13.9 per cent). In addition to age and sex, risk factors for postoperative death included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.
“We would normally expect mortality for patients having minor or elective surgery to be under one per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3 per cent) and elective surgery (18.9 per cent). 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.