Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
Author:
, McLean K A, Kamarajah S K, Chaudhry D, Gujjuri R R, Raubenheimer K, Trout I, Al Ameer E, Creagh-Brown B, Harrison E M, Nepogodiev D, Roslani A C, Li E, Pata F, Ramos-De la Medina A, van Ramshorst G H, Sayyed R, Simoes J, Smart N, Bhangu A, Glasbey James CORCID, Khaw R A, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Murray V, Thavayogan R, Yasin I, Glasbey J, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Edwards M, Lee M, Pinkney T, Pearse R, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Bhatia S, Kouli O, Salehi M, Tan H L, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James C E, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Siaw-Acheampong K, Benson R A, Bywater E, Dawson B E, Evans J P, Heritage E, Jones C S, Khatri C, Keatley J M, Knight A, Lawday S, Mann H S, Marson E J, Mckay S C, Mills E C, Pellino G, Picciochi M, Taylor E H, Tiwari A, Simoes J F F, Trout I M, Venn M L, Wilkin R J W, Smart N J, Minaya-Bravo A, Gallo G, Moug S, Di Saverio S, Vallance A, Vimalchandran D, Griffiths E A, Evans R P T, Townend P, Roberts K, McKay S, Isaac J, Satoi S, Edwards J, Coonar A S, Marchbank A, Caruana E J, Layton G R, Patel A, Brunelli A, Ford S, Desai A, Gronchi A, Fiore M, Almond M, Tirotta F, Dumitra S, Kolias A, Price S J, Fountain D M, Jenkinson M D, Hutchinson P, Marcus H J, Piper R J, Lippa L, Servadei F, Esene I, Freyschlag C, Neville I, Rosseau G, Schaller K, Demetriades A K, Robertson F, Alamri A, Shaw R, Schache A G, Winter S C, Ho M, Nankivell P, Rey Biel J, Batstone M, Ganly I, Vidya R, Wilkins A, Singh J K, Thekinkattil D, Sundar S, Fotopoulou C, Leung E, Khan T, Chiva L, Sehouli J, Fagotti A, Cohen P, Gutelkin M, Ghebre R, Konney T, Pareja R, Bristow R, Dowdy S, Rajkumar S T S, Ng J, Fujiwara K, Stewart G D, Lamb B, Narahari K, McNeill A, Colquhoun A, McGrath J, Bromage S, Barod R, Kasivisvanathan V, Klatte T, Abbott T E F, Abukhalaf S, Adamina M, Ademuyiwa A O, Agarwal A, Akkulak M, Alameer E, Alderson D, Alakaloko F, Albertsmeiers M, Alser O, Alshaar M, Alshryda S, Arnaud A P, Magne Augestad K, Ayasra F, Azevedo J, Bankhead-Kendall B K, Barlow E, Beard D, Blanco-Colino R, Brar A, Breen K A, Bretherton C, Lima Buarque I, Burke J, Chaar M, Chakrabortee S, Christensen P, Cox D, Cukier M, Cunha M F, Davidson G H, Di Saverio S, Drake T M, Edwards J G, Elhadi M, Emile S, Farik S, Fitzgerald E J, Garmanova T, Ghosh D, Mendonça Ataíde Gomes G, Grecinos G, Gründl M, Halkias C, Hisham I, Hutchinson P J, Hwang S, Isik A, Jonker P, Kaafarani H M A, Keller D, Kruijff S, Lawani I, Lederhuber H, Leventoglu S, Litvin A, Loehrer A, Löffler M W, Aguilera Lorena M, Marta Modolo M, Major P, Martin J, Mashbari H N, Mazingi D, Metallidis S, Mohan H M, Moore R, Moszkowicz D, Ng-Kamstra J S, Maimbo M, Negoi I, Niquen M, 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Abstract
Abstract
Background
This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.
Methods
This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection.
Results
This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001).
Conclusion
Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.
Funder
National Institute for Health Research NIHR Global Health Research Unit Grant Association of Coloproctology of Great Britain and Ireland Bowel & 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 The Urology Foundation Vascular Society for Great Britain and Ireland Yorkshire Cancer Research National Health Service UK Department of Health and Social Care
Publisher
Oxford University Press (OUP)
Cited by
32 articles.
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