TY - JOUR
T1 - Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection
T2 - An international cohort study
AU - COVIDSurg Collaborative
AU - Bhangu, Aneel
AU - Nepogodiev, Dmitri
AU - Glasbey, James C.
AU - Li, Elizabeth
AU - Omar, Omar M.
AU - Gujjuri, Rohan R.
AU - Morton, Dion G.
AU - Tsoulfas, George
AU - Keller, Deborah S.
AU - Smart, Neil J.
AU - Siaw-Acheampong, Kwabena
AU - Chaudhry, Daoud
AU - Dawson, Brett E.
AU - Evans, Jonathan P.
AU - Heritage, Emily
AU - Jones, Conor S.
AU - Kamarajah, Sivesh K.
AU - Khatri, Chetan
AU - Keatley, James M.
AU - Mckay, Siobhan C.
AU - Pellino, Gianluca
AU - Tiwari, Abhinav
AU - Trout, Isobel M.
AU - Wilkin, Richard J.W.
AU - Adamina, Michel
AU - Ademuyiwa, Adesoji O.
AU - Agarwal, Arnav
AU - Alameer, Ehab
AU - Alderson, Derek
AU - Alakaloko, Felix
AU - Alser, Osaid
AU - Arnaud, Alexis P.
AU - Augestad, Knut Magne
AU - Bankhead-Kendall, Brittany K.
AU - Barlow, Emma
AU - Benson, Ruth A.
AU - Blanco-Colino, Ruth
AU - Brar, Amanpreet
AU - Minaya-Bravo, Ana
AU - Breen, Kerry A.
AU - Buarque, Igor Lima
AU - Caruana, Edward J.
AU - Chakrabortee, Sohini
AU - Cox, Daniel
AU - Cunha, Miguel F.
AU - Davidson, Giana H.
AU - Desai, Anant
AU - Saverio, Salomone Di
AU - Drake, Thomas D.
AU - Edwards, John G.
AU - Elhadi, Muhammed
AU - Farik, Shebani
AU - Fiore, Marco
AU - Fitzgerald, J. Edward
AU - Ford, Samuel
AU - Gallo, Gaetano
AU - Ghosh, Dhruv
AU - Gomes, Gustavo Mendonça Ataíde
AU - Griffiths, Ewen A.
AU - Halkias, Constantine
AU - Harrison, Ewen M.
AU - Hutchinson, Peter J.
AU - Isik, Arda
AU - Jenkinson, Michael D.
AU - Kaafarani, Haytham M.A.
AU - Kolias, Angelos
AU - Lawani, Ismail
AU - Lederhuber, Hans
AU - Leventoglu, Sezai
AU - Löffler, Markus W.
AU - Martin, Janet
AU - Mashbari, Hassan N.
AU - Mazingi, Dennis
AU - Metallidis, Symeon
AU - Mohan, Helen M.
AU - Moore, Rachel
AU - Moszkowicz, David
AU - Moug, Susan
AU - Ng-Kamstra, Joshua S.
AU - Niquen, Milagros
AU - Ntirenganya, Faustin
AU - Outani, Oumaima
AU - Pata, Francesco
AU - Pinkney, Thomas D.
AU - Pockney, Peter
AU - Radenkovic, Dejan
AU - La Medina, Antonio Ramos De
AU - Roberts, Keith
AU - Roslani, April C.
AU - Salem, Hosni Khairy
AU - Santos, Irène
AU - Schache, Andrew
AU - Schnitzbauer, Andreas A.
AU - Sharma, Neil
AU - Shaw, Richard
AU - Shu, Sebastian
AU - Soreide, Kjetil
AU - Spinelli, Antonino
AU - Egan, Bridget
AU - Nizami, Kulsoom
N1 - Publisher Copyright:
Copyright © 2020 The Author(s). Published by Elsevier Ltd.
PY - 2020/7/4
Y1 - 2020/7/4
N2 - Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
AB - Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
UR - https://www.scopus.com/pages/publications/85087533576
U2 - 10.1016/S0140-6736(20)31182-X
DO - 10.1016/S0140-6736(20)31182-X
M3 - Article
SN - 0140-6736
VL - 396
SP - 27
EP - 38
JO - The Lancet
JF - The Lancet
IS - 10243
ER -
SDG 3 Good Health and Well-being