COVID-19 Patients Who Undergo Surgery at Increased Risk of Postoperative Death


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Patients undergoing surgery after contracting the novel Coronavirus (COVID-19) pandemic are at greater increased risk of postoperative death, a new global study reveals.

Prof. Adesoji Ademuyiwa of Paediatric Surgery at the University of Lagos and also Consultant Paediatric Surgeon, Lagos University Teaching Hospital, made this known in a statement on Saturday in Lagos.

He said researchers also 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”.

Ademuyiwa, also a Director, National Institute of Health Research Global Surgery Unit, College of Medicine of the University of Lagos, participated in the study.

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He said: “This study has shown clearly that non-emergent and non-urgent surgery during the period of the COVID-19 pandemic is associated with higher mortality rates.

“The outcomes of surgery in COVID-19 positive patients are much poorer than those without the disease.

“The degree of morbidity and mortality in a patient who even underwent minor surgeries is comparable with those of life-threatening conditions in the pre-pandemic period.”

Ademuyiwa said that a recent estimate showed that in Nigeria, at least about 120,000 surgeries must have been postponed due to the pandemic.

“Without doubt, the result of this current study showed that it was sound reasoning for hospitals in the country to have postponed elective and non-critical surgeries during the pandemic.

“That decision must have saved lives, limbs and organs.

“The study found that overall, in the 30 days following surgery, 51 per cent 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,” he said.

In his contributions, Aneel Bhangu, also a Senior Lecturer in Surgery at the University of Birmingham, who co-authors the Report, said: “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%) and elective surgery (18.9%).

“In fact, these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

“For example, the 2019 UK National Emergency Laparotomy Audit reported a 30-day mortality of 16.9 per cent in the highest-risk patients.

“And, a previous study across 58 countries reported a 30-day mortality of 14.9 per cent in patients undergoing high-risk emergency surgery.

“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.”

Bhangu said that patients undergoing surgery were “a vulnerable group at risk of SARS-CoV-2 exposure in hospital”.

According to him, they may be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

Another co-author, Dmitri Nepogodiev, a Research Fellow at the University of Birmingham said: “Worldwide, an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19.

“Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital.

“There’s now an urgent need for investment by governments and health providers into measures to ensure that as surgery restarts, patient safety is prioritised.

“These include the provision of adequate personal protective equipment (PPE), the establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated ‘cold’ surgical centres.”

In the study, researchers examined data for 1,128 patients from 235 hospitals.

A total of 24 countries participated, predominantly in Europe, although hospitals in Africa, Asia, and North America also contributed.

The reports state that overall 30-day mortality in the study was 23.8 per cent.

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%).

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.

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