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• W3095972699 abstract "Surgery is the major collateral damage of the COVID-19 pandemic. During initial waves, at least 28 million elective operations were cancelled.1COVIDSurg CollaborativeElective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans.Br J Surg. 2020; 11 (10.1002/bjs.11746.)Google Scholar We thank clinicians and researchers for their responses to our study2COVIDSurg 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 (1093) Google Scholar 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. Hytham Hamid, Harsha Shanthanna and Vishal Uppal, and Lewis Meecham and colleagues raise issues around the relevance of patient subgroups. Hamid identifies that the benefits of minimally invasive surgery need to be balanced against the theoretical risks of aerosolisation of peritoneal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although we cannot comment on the safety for health-care workers, we are further analysing data to explore the effects of minimally invasive surgery versus open surgery on patients. Shanthanna and Uppal suggest that, in our data, regional anaesthetic techniques might be associated with reduced risk of complications from surgery. However, we advise caution in interpretation of this non-randomised study, in which the type of procedure and anticipated operative risk could have influenced choice of anaesthesia. Meecham and colleagues suggest that venous thromboembolism rates were low, although comparison with historical studies is dependent on the patient mix. We are assessing data from 35 000 elective cancer operations, done during the pandemic, to identify thrombosis rates in patients with and without SARS-CoV-2 infection. This direct comparison will allow us to identify any benefits for enhanced prophylaxis. Jeremy Rodrigues and colleagues, Joseph Alderman, and Seenu Vuthaluru and colleagues highlight the unknowns that need to be addressed to prepare for future pandemic waves. Rodrigues and colleagues identify that our study might have missed some patients with asymptomatic SARS-CoV-2 infection, because testing was not routine in early phases of the pandemic, which might have inflated the mortality rate. However, deaths following minor operations and in low-risk groups are generally preventable, and our statements on excess risk stand true. Alderman identifies that the intermediate-term risks of SARS-CoV-2 infection are unknown. We are analysing an early cohort of swab-positive patients whose operation was delayed, to assess whether postponing surgery reduces health risks. Vuthaluru and colleagues highlight the need for accurate risk stratification to plan safe delivery of surgery during future pandemic waves. We are using machine learning to identify patients at lowest risk of pulmonary complications associated with COVID-19, in whom surgery should not be delayed. In October, 2020, the GlobalSurg-COVIDSurg week cohort study will have captured all inpatient surgeries in over 1400 hospitals worldwide, and we will continue to fill these knowledge gaps using the data from this study. We declare no competing interests. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the UK Department of Health and Social Care. Download .pdf (.03 MB) Help with pdf files Supplementary appendix 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 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 pandemicThe COVIDSurg Collaborative1 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. 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" @default.
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