The wave of COVID research continues, much of it low-quality and hurriedly published. This is apparently the norm for academic publishing during a pandemic: fast, furious and haphazard.
However, two very significant reviews appeared in The Lancet this week that impact and inform anaesthetists and other critical care specialists.
Post-operative mortality, COVID & surgery
Early pandemic data suggested that COVID-19 patients having even minor elective surgery suffered worse post-operative outcomes, particularly high post-operative mortality. The COVIDSurg Collaborative has confirmed this after a multicenter trial across 24 countries.
Across the entire 1,128 patient cohort, 30-day mortality was a jaw-dropping 24%. Yes, 1 in 4 died within 30 days of surgery.
Pulmonary complications (pneumonia, ARDS or unexpected post-op ventilation) were very common (51%) and were associated with an even higher mortality (38%; and 83% of all deaths). Mortality was unsurprisingly associated with older age ≥ 70 years, male sex, ASA ≥ 3, emergency surgery, major surgery, and malignancy.
But even among low-risk groups, post-operative mortality was shockingly high: 30-49 year olds (6%), women (18%), ASA 1-2 patients (12%), and even those without comorbidities (7%). Being asymptomatic at admission did not have a significant protective effect (22% vs 27% mortality).
Elective surgery still carried a 19% mortality rate, and even for minor surgery mortality was 16%! Anaesthesia modality (local, regional or GA) did not have a significant impact.
Click through to read the summary or full-text, though the obvious take-away is that non-essential surgery should be avoided as much as is possible in those with confirmed or suspected COVID.
This will have huge implications for recommencement of elective surgery in many pandemic-hit countries. (Cook & Harrop-Griffiths explore this very topic in an NHS-context in their recent editorial.)