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Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Abstract: 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 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28-2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65-3·22], p<0·0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2·35 [1·57-3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01-2·39], p=0·046), emergency versus elective surgery (1·67 [1·06-2·63], p=0·026), and major versus minor surgery (1·52 [1·01-2·31], p=0·047). 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.

 Fuente: Lancet . 2020 Jul 4;396(10243):27-38

 Editorial: Elsevier

 Año de publicación: 2020

 Nº de páginas: 12

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/S0140-6736(20)31182-X

 ISSN: 0140-6736,1474-547X

 Url de la publicación: https://doi.org/10.1016/ S0140-6736(20)31182-X

Autoría

COVIDSURG COLLABORATIVE

NEPOGODIEV, DMITRI

BHANGU, ANEEL

GLASBEY, JAMES C

LI, ELIZABETH

OMAR, OMAR M

SIMOES, JOANA FF

ABBOTT, TOM EF

ALSER, OSAID

ARNAUD, ALEXIS P

BANKHEAD-KENDALL, BRITTANY K

BREEN, KERRY A

CUNHA, MIGUEL F

DAVIDSON, GIANA H

SAVERIO, SALOMONE DI

GALLO, GAETANO

GRIFFITHS, EWEN A

GUJJURI, ROHAN R

HUTCHINSON, PETER J