Surgery during the COVID-19 pandemic
Authors: Seenu Vuthaluru, Sreedharan V Koliyadan, Sureshkannan S Kanniwadi
Journal: The Lancet (2020)

The COVIDSurg Collaborative1COVIDSurg CollaborativeMortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study.Lancet. 2020; 396: 27-38Summary Full Text Full Text PDF PubMed Scopus (1230) Google Scholar reported high postoperative mortality (268 [23·8%] of 1128 patients) and pulmonary complications (577 [51·2%]) from patients in 235 hospitals in 24 countries over a 3-month period. This study included patients from countries with high and low prevalence of SARS-CoV-2 and case fatality rates, and it will be interesting to know whether the mortality and pulmonary complications are similar between each country. This information will have important implications for planning management strategies. Unlike the general population with COVID-19, this study1COVIDSurg CollaborativeMortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study.Lancet. 2020; 396: 27-38Summary Full Text Full Text PDF PubMed Scopus (1230) Google Scholar included a large number of patients at high risk of developing pulmonary complications and have undergone emergency surgery (835 [74·0%] of 1128), were at grade 3–5 on the American Society of Anesthesiologists (ASA) scale, had gastrointestinal and general procedures (373 [33·1%]), and had orthopaedic surgery (302 [26·8%]). Can these observations be generalised to patients with low-risk elective surgeries, such as breast and thyroid surgery, which are ASA grade 1–2? It is important to note that patients (especially those with cancer) who are being denied treatment due to the fear of SARS-CoV-2 infection are at a greater risk of morbidity and mortality as a result of the primary pathology, and delaying surgery for these patients will create a huge backlog for health-care services.2Myles PS Maswime S Mitigating the risks of surgery during the COVID-19 pandemic.Lancet. 2020; 396: 2-3Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar Informed decision making, use of appropriate protective measures by the patients and health-care workers, and careful selection of patients for low-risk elective surgery (especially in regions with low prevalence of SARS-CoV-2 and low case fatality) might therefore aid in providing timely treatment. We declare no competing interests. Surgery during the COVID-19 pandemicThe COVIDSurg Collaborative's study1 of surgical outcomes in patients with COVID-19 is commendable, as most existing publications around perioperative practice are commentaries or recommendations with extrapolated knowledge. Full-Text PDF Surgery during the COVID-19 pandemicThe COVIDSurg Collaborative1 highlights a concerningly high rate of postoperative pulmonary complications and high mortality in a large cohort of perioperative patients with known or highly suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Male patients at high risk (American Society of Anesthesiologists grades 3–5) and those patients undergoing emergency or major surgery fared the worst in terms of 30-day mortality. Cancer surgery was also linked to elevated mortality, although non-urgent procedures might have been postponed during the first COVID-19 pandemic peak, which could have altered the patient mix. Full-Text PDF Surgery during the COVID-19 pandemicThe COVIDSurg Collaborative1 evaluated 30-day postoperative mortality and pulmonary complications in 1128 patients with COVID-19. This included 421 (37%) patients undergoing abdominal surgery. Pulmonary complications were reported in 577 (51·2%) of 1128 patients, with a high 30-day mortality rate of 23·8% (219 of 577). These outcomes might mainly relate to impaired cell-mediated immunity associated with the acute phase of COVID-192 and the absence of an effective drug therapy. Full-Text PDF Surgery during the COVID-19 pandemicWe read with great interest the Article by the COVIDSurg Collaborative.1 It is now recognised that patients diagnosed with COVID-19 have a higher risk of venous thromboembolism compared with patients who do not have COVID-192 and that abnormal coagulation markers seen in patients with COVID-19 are associated with higher mortality.2,3 Standard protocols used for venous thromboembolism prophylaxis might be less effective in these patients.4 The COVIDSurg Collaborative1 found surprisingly low rates of pulmonary embolism 30 days after surgery (four [1·4%] of 280 patients after elective surgery vs 18 [2·2%] of 835 patients after emergency surgery) in patients who had severe acute respiratory syndrome coronavirus 2 infection. Full-Text PDF Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort studyPostoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Full-Text PDF Open AccessSurgery during the COVID-19 pandemicWe fear that limitations of the COVIDSurg Collaborative's study1 risk compromising patient care. Full-Text PDF Surgery during the COVID-19 pandemic – Authors' replySurgery is the major collateral damage of the COVID-19 pandemic. During initial waves, at least 28 million elective operations were cancelled.1 We thank clinicians and researchers for their responses to our study2 that highlighted the remaining knowledge gaps that are preventing surgery from being re-established safely during recovery from the first COVID-19 pandemic wave and in subsequent waves. Full-Text PDF