Mortality after surgery with SARS-CoV-2 infection in England: a population-wide epidemiological study

Abstract

Background: The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated mortality after surgery. Methods: Analysis of routine electronic health record data from NHS hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between January 1, 2020 and February 28, 2021. The exposure was SARS-CoV-2 infection defined by International Classification of Diseases (ICD)-10 codes. The primary outcome measure was 90 day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, Index of Multiple Deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals (CI). Results: We identified 2 666 978 patients undergoing surgery of whom 28 777 (1.1%) had SARS-CoV-2 infection. In total, 26 364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6153/28 777 [21.4%] vs no SARS-CoV-2: 20 211/2 638 201 [0.8%]; OR¼5.7 [95% CI, 5.5e5.9]; P<0.001). Amongst patients undergoing elective surgery, 2412/1 857 586 (0.1%) had SARS-CoV-2, of whom 172/2412 (7.1%) died, compared with 1414/1 857 586 (0.1%) patients without SARS-CoV-2 (OR¼25.8 [95% CI, 21.7e30.9]; P<0.001). Amongst patients undergoing emergency surgery, 22 918/582 292 (3.9%) patients had SARS-CoV-2, of whom 5752/22 918 (25.1%) died, compared with 18 060/559 374 (3.4%) patients without SARS-CoV-2 (OR¼5.5 [95% CI, 5.3e5.7]; P<0.001). Conclusions: The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.

When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA

“…However at this time, due to missing studies, no recommendations could be made for the optimal time period between SARS-CoV-2 infection and elective surgery. Up to date, there are many publications, analyzing the perioperative mortality of patients with perioperative SARS-CoV-2 infection [ 100 ] and giving an evidence-based statement on postponing elective surgical interventions [ 101 ]. Table 1 summarizes some selected publications from the onset of the pandemic to the appearance of studies that examine the time interval in more detail [ 8 , 102 – 110 ].…”

Timing of elective surgery and risk assessment after SARS‐CoV‐2 infection: an update

“…Pre‐operative SARS‐CoV‐2 infection was previously shown to be associated with significantly increased risks of morbidity and mortality. Data in the early phases of the pandemic demonstrated that peri‐operative SARS‐CoV‐2 infection was associated with clinically important increases in mortality, in some cases more than a 10‐fold increase [ 1 , 2 ]. Furthermore, when surgery was undertaken within 6 weeks of infection, postoperative morbidity and mortality were also increased [ 3 ].…”

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

“…Preoperative SARS-Cov-2 infection was previously known to be associated with a significant increased risk of morbidity and mortality. Data from the early phase of the pandemic showed that a perioperative infection from SARS-Cov-2 was clinically associated with an important increase in mortality, in some cases, as much as 10 times [ 6 , 7 ]. Furthermore, when surgery was undertaken within 6 weeks of infection, both postoperative morbidity and mortality increased [ 8 ].…”