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Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic.

Publication ,  Journal Article
STARSurg Collaborative and COVIDSurg Collaborative
Published in: Br J Surg
December 1, 2021

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.

Duke Scholars

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Published In

Br J Surg

DOI

EISSN

1365-2168

Publication Date

December 1, 2021

Volume

108

Issue

12

Start / End Page

1448 / 1464

Location

England

Related Subject Headings

  • Surgery
  • Respiratory Distress Syndrome
  • Respiration, Artificial
  • Postoperative Complications
  • Pandemics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Elective Surgical Procedures
 

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STARSurg Collaborative and COVIDSurg Collaborative. (2021). Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic. Br J Surg, 108(12), 1448–1464. https://doi.org/10.1093/bjs/znab336
STARSurg Collaborative and COVIDSurg Collaborative. “Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic.Br J Surg 108, no. 12 (December 1, 2021): 1448–64. https://doi.org/10.1093/bjs/znab336.
STARSurg Collaborative and COVIDSurg Collaborative. Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic. Br J Surg. 2021 Dec 1;108(12):1448–64.
STARSurg Collaborative and COVIDSurg Collaborative. “Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic.Br J Surg, vol. 108, no. 12, Dec. 2021, pp. 1448–64. Pubmed, doi:10.1093/bjs/znab336.
STARSurg Collaborative and COVIDSurg Collaborative. Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic. Br J Surg. 2021 Dec 1;108(12):1448–1464.
Journal cover image

Published In

Br J Surg

DOI

EISSN

1365-2168

Publication Date

December 1, 2021

Volume

108

Issue

12

Start / End Page

1448 / 1464

Location

England

Related Subject Headings

  • Surgery
  • Respiratory Distress Syndrome
  • Respiration, Artificial
  • Postoperative Complications
  • Pandemics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Elective Surgical Procedures