Covid-19 patients face 'greatly increased risk' of post-surgery death, says Birmingham study

PATIENTS undergoing surgery after contracting coronavirus are at “greatly increased risk of postoperative death”, warns a new research, which recommends raising thresholds for surgery during the pandemic.

Mortality rate among Covid-19 patients who underwent surgery “approach those of the sickest patients admitted to intensive care” due to coronavirus complications, said the study published in The Lancet.

Experts at the University of Birmingham-led NIHR Global Research Health Unit on Global Surgery analysed data of 1,128 patients from 235 hospitals in 24 countries across the globe.

They found that Covid-19 patients who undergo surgery had “substantially worse postoperative outcomes” than what would be expected for uninfected patients.

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).

The study noted that mortality rates were higher in men at 28.4 per cent against 18.2 per cent among women.

People aged over 70 had a more than double the mortality risk (33.7 per cent) when compared with younger patients (13.9 per cent).

Report co-author Dr 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 1%, 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."

Moreover, patients undergoing surgery are a vulnerable group at risk coronavirus exposure, “particularly susceptible to subsequent pulmonary complications”.

The study also found that 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation in the 30 days after surgery. This, researchers said, may explain the high mortality, as 81.7 per cent of patients who died had experienced pulmonary complications.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by Covid-19,” noted report co-author Dmitri Nepogodiev, Research Fellow at the University of Birmingham.

"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 in to measures to ensure that as surgery restarts patient safety is prioritised. This includes provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres."