Mortality and Pulmonary Complications in Patients Undergoing Surgery with Peri-operative SARS-COV-2 Infection: An International Cohort Study

 COVIDSurg Collaborative

The Lancet 2020, 396, Issue 10243, 27-38

Aim of Study

To review mortality and pulmonary complication rates in patients undergoing surgery with peri-operative COVID-19 infection and identify risk factors for these outcomes.

Design and Location

Prospective and retrospective observational cohort study

Multi-centre – 24 countries, 235 hospitals

Methodology

All patients undergoing any type of surgery from the period 01/01/20 to 31/03/20 who were diagnosed with COVID-19 <7 days pre-operatively or <30 days post-operatively who had 30 day follow up by 31/03 were included.

Any surgical procedure for any indication.

COVID-19 diagnosed by lab PCR results, CT chest findings or senior clinician opinion based on presenting symptoms.

Primary Outcome

30 day mortality

Secondary Outcomes

Rate of pulmonary complications (pneumonia, ARDS, unexpected invasive/non-invasive ventilation/failure to extubate)

Statistics

STROBE guidelines for observational studies

Results presented as mean with confidence intervals and odds ratios used to show significance.

X2 and Fishers exact tests to show differences between groups.

Results

1128 patients included with 54% male.

Overall all-cause mortality rate of 23.8%

Overall pulmonary complication rate 51.2% (pneumonia 40%, ARDS 14%, unexpected ventilation 21%).

Significantly increased risk of mortality in:

  • Patients >70
  • Males
  • ASA grade 3-5
  • Emergency/major/cancer surgery

Mortality rate in patients with pulmonary complications 38%

Significantly increased risk of pulmonary complications in:

  • ASA Grade 3-5

Conclusions/Discussions

Significantly higher risk of pulmonary complications in patients with peri-operative COVID compared to those without 50% vs 8% in pre-pandemic studies.

Significantly higher risk of mortality in patients with peri-operative COVID compared to those without 23.8% vs 17% in high risk NELA patients.

Stated Limitations from the Study

Multi-centre ?comparability of results

No control groups – comparison to pre-pandemic mortality and pulmonary complication rates only.

No standardised inclusion criteria – swab vs CT vs clinician opinion

Small cohort considering multicentre and timescale of study

Discussion from Journal Club Meeting (?Change of Practice)

Small cohort may represent scaled back capacity for operations during pandemic and cancellation of electives.

Would be interesting to compare outcomes in this cohort to patient group without COVID who underwent surgery during the same period (mortality rates could be worse during strained period of pandemic) and also COVID positive patients who did not undergo surgery.

Summary by Dr D Caldow. Journal Club Meeting 10 September 2020.

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