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

19 Jun, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has now spread to most countries, with WHO declaring a COVID-19 pandemic on March 11, 2020. The pandemic has tested the resilience of health-care systems, including hospitals, which were largely unprepared for the scale of the pandemic. Patients having surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital and might be particularly susceptible to subsequent pulmonary complications, due to the pro-inflammatory cytokine and immunosuppressive responses to surgery and mechanical ventilation.

Evidence of the safety of performing surgery in SARS-CoV-2-exposed hospitals is urgently needed. Before the SARS-CoV-2 pandemic, high-quality, multinational observational studies established overall baseline rates of postoperative pulmonary complications (up to 10%) and subsequent mortality (up to 3%) after surgery. With initiatives such as the UK's National Emergency Laparotomy Audit (NELA), mortality was improving even in high-risk groups.

Guidelines have been published for the management of surgical patients during the SARS-CoV-2 pandemic but they are based solely on expert opinion. The impact of SARS-CoV-2 on postoperative pulmonary complications and mortality needs to be established in order to enable surgeons and patients to make evidence-based decisions during the pandemic. This study reports the clinical outcomes of patients who had surgery with perioperative SARS-CoV-2 infection, including the impact of pulmonary complications.

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