More risk of postoperative death for coronavirus surgeries

A new study has found that patients undergoing surgery after contracting coronavirus are at greatly increased risk of postoperative death.

Research in The Lancet has shown 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.

Having examined data for 1,128 patients from 235 hospitals, researchers at the University of Birmingham-led NIHR Global Research Health Unit on Global Surgery have now published their findings that SARS-CoV-2 infected patients who undergo surgery experience substantially worse postoperative outcomes than would be expected for similar patients who do not have SARS-CoV-2 infection.

Overall 30-day mortality in the study was 23.8 per cent. Mortality was disproportionately high 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).

Aneel Bhangu, senior lecturer in Surgery at the University of Birmingham, 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 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; for example, the 2019 UK National Emergency Laparotomy Audit reported 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."