CAPE TOWN – Patients who undergo surgery after contracting Covid-19 are at a greater risk of postoperative death, occurring within 30 days after surgery in or out of the hospital, a global study published in The Lancet revealed.
Researchers found that amongst Covid-19 positive patients who underwent surgery, mortality rates approach those of the sickest patients admitted to intensive care after becoming infected with the Coronavirus in the community.
The study was based on data from 1 128 patients from 235 hospitals across 24 countries, predominantly in Europe but included continents such as Africa, Asia, and North America.
Professor Bruce Biccard, Second Chair in the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town (UCT), said: “This new study suggests that patients who are infected with Covid-19 around the time of surgery have a high mortality and pneumonia rate. This is going to make the re-introduction of elective surgery diﬃcult, due to the high prevalence of Covid-19 infected patients in the community who are going to need surgery.”
Biccard warned that the study should not halt all surgical procedures, whether elective, urgent or emergency.
“What it does highlight is the need for particular attention to be focused on these patients in the post-operative period,” he said.
Professor Martin Smith, Academic Head of Surgery at the University of the Witwatersrand said: ” 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 after the ﬁrst week after the operation. They are at risk for lung complications.”
According to the study, patients undergoing surgery are a particularly vulnerable group if exposed to Covid-19 in hospital. Due to inﬂammatory and immunosuppressive responses to surgery and mechanical ventilation, they may be particularly susceptible to subsequent pulmonary complications.
In the 30 days following surgery, 51 percent of patients enrolled in the study developed pneumonia, acute respiratory distress syndrome, or required unexpected ventilation. This may explain the high mortality, about 87 percent of the patients who died had experienced pulmonary complications.
Overall 30-day mortality in the study was 23.8 percent. Mortality was disproportionately high across all subgroups, including elective surgery at 18.9 percent and emergency surgery, at 25.6 percent.
The study found that the mortality rates were higher in men, at 28.4 percent versus the 18.2 percent in women. The rate for patients aged 70 years or over was at 33.7 percent while the rate for those aged under 70 years was at 13.9 percent.
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