Surgery puts COVID-19 patients at higher risk

Special to Western News

Findings from a study by the CovidSurg Collaborative research team, which includes Western professor Janet Martin, should guide decision-making about when to perform, postpone or cancel procedures as elective surgeries resume around the globe,

COVID-19 patients who undergo surgery face increased risks of pulmonary complications or even death when compared to those not suffering from the disease, according to a recent international study. The findings should guide decision-making about when to perform, postpone or cancel procedures as elective surgeries resume around the globe, researchers explained.

The CovidSurg Collaborative international research team, including Schulich School of Medicine & Dentistry professor Janet Martin, explored data for 1,128 patients from 235 hospitals in 24 countries for the study.

Their findings showed 30-day mortality for COVID-19 patients who underwent surgery was almost 1-in-4, 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).

More than half of patients (51 per cent) developed pulmonary complications within 30 days after surgery.

The study, Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study, was recently published in the journal The Lancet.

“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,” Martin said. “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 1 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,” explained co-author Aneel Bhangu of the University of Birmingham.