Surgery risk for virus patients
There are higher rates of mortality and pulmonary complications 30 days after surgery, study finds
A STUDY has found that Covid-19 might have dire consequences for those affected when they undergo surgery.
The international study, published in the Lancet, found that 30 days after surgery, patients had higher rates of mortality and pulmonary complications.
University of Birmingham experts found that Covid-19 positive patients had substantially worse post-operative outcomes than Covid-19 negative patients.
Data for 1 128 patients from 235 hospitals was analysed in 24 countries in Europe, Africa, Asia and North America, and contributed to the study.
Overall, 30-day mortality in the study was 23.8%. Mortality was disproportionately high across all subgroups, including elective surgery (18.9%), emergency surgery (25.6%), minor surgery such as simple appendectomy or hernia repair (16.3%), and major surgery such as hip surgery or colon cancer surgery (26.9%).
In the 30 days after surgery, 51% of patients enrolled in the study developed pneumonia, acute respiratory distress syndrome, or required unexpected ventilation. This might explain the high mortality because most (81.7%) patients who died had experienced pulmonary complications.
The study said: “The increased risks associated with Sars-CoV-2 infection should be balanced against the risks of delaying surgery in individual patients.
“This study identified men, people aged 70 years or older, those with comorbidities, those having cancer surgery, and those needing emergency or major surgery as being most vulnerable to adverse outcomes.”
It said consideration should be given to postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery, especially in older men.
Academic head of surgery at the University of the Witwatersrand, Professor Martin Smith, said the findings meant extra attention needed to be paid to Covid-19 patients and not the halting of surgical procedures.
A modelling study published in the British Journal of Surgery indicated that about 28 million elective surgeries in the world could be cancelled because of the pandemic. It was estimated South Africa could have more than 140 000 cancelled surgeries, including 12 000 cancer procedures.
Smith called for more vigilance, not cancelling surgeries. “Most of the patients (75%) had an emergency operation. In general, these are unavoidable operations and therefore the important lesson is that we need to be more vigilant with these patients, especially after the operation and the first week after the operation.
“They are at risk of lung complications. What is not yet clear is if there is anything we can do to change the course of this risk given that the operation is urgently required and that in South Africa most of these operations will be done outside academic and central hospitals where access to ICU and specialist care is limited.”
Professor Bruce Biccard, a former president of the South African Society of Anaesthesiologists, said:. “To ensure a healthy population we need to ensure these surgeries are done soon. This study suggests that patients who are infected with Covid-19 at the time of surgery have a high mortality and pneumonia rate. This will make the re-introduction of elective surgery difficult due to the high prevalence of Covid-19 infected patients in the community who will need surgery.”