Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 82·6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28-2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65-3·22], p<0·0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2·35 [1·57-3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01-2·39], p=0·046), emergency versus elective surgery (1·67 [1·06-2·63], p=0·026), and major versus minor surgery (1·52 [1·01-2·31], p=0·047). Interpretation: Postoperative 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.

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study / Nepogodiev, Dmitri; Glasbey, James C; Li, Elizabeth; Omar, Omar M; Simoes, Joana FF; Abbott, Tom EF; Alser, Osaid; Arnaud, Alexis P; Bankhead-Kendall, Brittany K; Breen, Kerry A; Cunha, Miguel F; Davidson, Giana H; Di Saverio, Salomone; Gallo, Gaetano; Griffiths, Ewen A; Gujjuri, Rohan R; Hutchinson, Peter J; Kaafarani, Haytham MA; Lederhuber, Hans; Löffler, Markus W; Mashbari, Hassan N; Minaya-Bravo, Ana; Morton, Dion G; Moszkowicz, David; Pata, Francesco; Tsoulfas, George; Venn, Mary L; Bhangu, Aneel; Cox, Daniel; Roslani, April C; Alakaloko, Felix; de Vries, Jean-Paul PM; Aaraj, Mahmoud A; Abbott, Tom EF; Abbott, Sarah J; Abdalla, Mutwakil OM; Abdelaal, Ahmed S; Ademuyiwa, Adesoji O; Aherne, Thomas M; Ali, Osman M; Alkadeeki, Ghadah Z; Almeida, Ana C; Alrahawy, Mahmoud M; Ambler, Graeme K; Alameer, Ehab; Andreani, Stefano M; De Andrés-Asenjo, Beatriz; Antonanzas, Leyre Lopez; Aoun, Salah G; Ashoush, Fouad M; Augestad, Knut Magne; Avellana, Rocio B; Ayeni, Funbi A; Ayorinde, John OO; Babu, Bheemanakone H; Baig, Mirza MAS; Bajomo, Oreoluwa M; Baker, Olivia J; Baker, Markus P; Baldwin, Alexander J; Ban, Vin Shen; Baron, Ryan D; Barranquero, Alberto G; Barry, Conor P; DI Bartolomeo, Alessandro; Bass, Gary A; Bath, Michael F; Batjer, H Hunt; Beamish, Andrew J; Belgaumkar, Ajay P; Bence, Matthew N; Benson, Ruth A; Bernal-Sprekelsen, Juan Carlos; Bhama, Anuradha R; Bhavaraju, Avi V; Biffl, Walter L; Blundell, Chris M; Boddy, Alexander P; Borgstein, Alexander BJ; Bosanquet, David C; Bosch, Karen D; Bouhuwaish, Ahmad EM; Bozkurt, Mehmet A; Brathwaite, Collin EM; Brown, Benjamin C; Brown, Oliver D; Brown, Allison K; Buarque, Igor Lima; Bueno-Cañones, Alejandro D; Bulugma, Mustafa R; Burke, Joshua R; Byrne, Matthew HV; Cagigal-Ortega, Elima P; Callcut, Rachael A; DI Candido, Francesca; Canova, Michaela E; Carlos, William J; Caruana, Edward J; Cato, Liam D; Catton, Andrew B; Ceretti, Andrea Pisani; Chase, Thomas JG; Chiara, Francesco Di; Chowdhury, Abeed H; Chung, Eric A; Cicerchia, Pierfranco M; Clough, Ethan CS; Coleman, Natasha L; Collins, Chris G; Collins, Michelle L; Colonna, Emily T; Comini, Lara V; Connolly, Tara M; Coughlin, Patrick A; Cruzado, Laura Fernández-Gomez; Davidson, Brian R; Davies, Richard J; Davies, Emma J; Davis, Niall F; Dawson, Brett E; Dean, Benjamin JF; Delgado, Maria Garcia-Conde; Diaz, Jose J; Dickson, Kathryn E; Diez-Alonso, Manuel M; Dixon, Jan R; Doe, Matthew J; Drake, Thomas D; Drake, Frederick T; Duffy, John P; Dunne, Declan FJ; Dunne, Naomi JM; Durán-Muñoz-Cruzado, Virginia M; Durst, Alexander ZE; Eardley, Nicola J; Edwards, John G; Elfallal, Ahmed H; Elfiky, Mahmoud MA; Elliott, Jessie A; Emile, Sameh H; Emslie, Katy M; Endorf, Frederick W; Engel, Jamie L; Enjuto, Diego T; Etchill, Eric W; Evans, Jonathan P; Fahey, Brian A; Faria, Carlos S; Feo, Carlo V; Ferguson, Henry JM; Fernandez, Beatriz Dieguez; Fernandez, Andres Garcia; Fernández, Antonio J; Fernández-Pacheco, Borja Camacho; Fitzgerald, J Edward; Fonsi, Giovanni B; Font, Roser Farré; Fowler, Amy L; Franco, Gregorio Di; Fretwell, Kenneth R; Fructuoso, Lorena Sanchon; Fusai, Giuseppe K; Garcia, Miguel Hernandez; Garcia-Ureña, Miguel Angel; Gill, Charn K; Gisbertz, Suzanne S; Del Giudice, Roberto; Giuffrida, Maria Carmela; Di Giuseppe, Matteo; Gómez, María Fanjul; González, Javier Serrano; Griffiths, Ewen A; Guariglia, Claudio A; Hainsworth, Alison J; Hall, Bria J; Hall, James RW; Hammond, John S; Haqqani, Maha H; Harrison, Ewen M; Hazelton, Joshua P; van Heinsbergen, Maarten; Hill, Arnold DK; Hing, Caroline B; Hirji, Sameer A; Ho, Michael WS; Holbrook, Charlotte M; Holme, Thomas J; Hopkins, James C; Hopkinson, David N; Hossain, Fahad S; Hudson, Victoria E; Hughes, Jane L; Hwang, E. Shelley; Ibrahim, Mohamed AH; Isolani, Simone M; Jara, Pablo Galindo; Jenkinson, Michael D; Jenny, Hillary E; Jeyaretna, Deva S; Jones, Robert P; Jones, Andrew P; Jonker, Pascal KC; Jönsson, Maria L; Joyce, Doireann P; Kalkwarf, Kyle J; Kamarajah, Sivesh K; El Kassas, Mohamed; Kavanagh, Dara O; Keatley, James M; Khalefa, Mohamed A; Khan, Jim S; Kirmani, Bilal H; Kisiel, Aaron P; Kouris, Spyros Marinos; Kowal, Mikolaj R; Labib, Peter L; Larkin, John O; Lauscher, Johannes C; Leclercq, Wouter KG; Ledesma, Frances SJ; Leite-Moreira, André M; Leung, Elaine YL; Lewis, Sophia E; Lima, Maria João; Lin, Daniel J; Liu, Helen H; Lowery, Aoife J; Lozano, Saida Martel; Luney, Catriona R; Maia, Mariana Magalhães; Mariani, Nicolò M; Marino, Marco V; Marra, Angelo A; Marsh, Christopher L; Martin, Robert CG; McCluney, Simon J; McIntyre, Robert C; Mckay, Siobhan C; McKevitt, Kevin L; Meagher, Ashley D; Mehdi, Mohammad Q; Mehigan, Brian J; Gonzalez-De Miguel, Melania; De Miguel-Ardevines, Maria-Carmen; Miguel-Mendez, Carlos San; 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Anwar, Sibtain; Anwer, Mariyah; Aragon-Chamizo, Juan; Ardito, Antonella; Arigoni, Michele; Armao, Teodora; Arminio, Armando; Armstrong, Lara; Arnaud, Alexis; Asaad, Peter; Ashcroft, James; Ashmore, Christopher; Asqalan, Ahmad; Asti, Emanuele; Aubry, Emmanuelle; Aytac, Erman; Ayuso-Herrera, Esther; Baeza, Melody; Bailon-Cuadrado, Martin; Bakmaz, Bernarda; Baldi, Caterina; Baldini, Edoardo; Baldo, Stefano; Ballabio, Michele; Baloyiannis, Ioannis; Baltazar, Gerard; Bàmbina, Fabrizio; Bandiera, Alessandro; Barlow, Emma; Barmasse, Roberto; Barmpagianni, Christina; Baronio, Gianluca; Barra, Fabio; Bartsch, Anne-Marie; Basgaran, Amedra; Basha, Amr; Bashkirova, Varvara; Bastazza, Marco; Baumber, Rachel; Belcher, Elizabeth; Belvedere, Angela; Benítez-Linero, Inmaculada; Bergeat, Damien; Bernasconi, Matteo; Bhalla, Ashish; Bhutiani, Neal; Bianco, Federica; Bisagni, Pietro; Blake, Iain; Blanco-Colino, Ruth; Blazquez-Martin, Alma; Boal, Matthew; Bonavina, Luigi; Bonavina, Giulia; Bond-Smith, Giles; Booth, Karen; Borges, Filipe; Borghi, Felice; Bouchagier, Konstantinos; Bourke, Grainne; Boyle, Emily; Brachini, Gioia; Brain, Jessie; Brar, Amanpreet; Breckles, Lisa; Bretagnol, Frédéric; Brixton, Genevieve; Bruzzaniti, Placido; Bueser, Teofila; Burnside, Nathan; Caballero, Albert; Calcerrada-Alises, Enrique; Callahan, Miriam; Camarero, Enrique; Campagnaro, Tommaso; Campanelli, Michela; Candiani, Massimo; Cannoletta, Marina; Cantalejo-Diaz, Miguel; Cao, Han; Capelli, Patrizio; Capizzi, Vita; Carcano, Giulio; Carissimi, Francesca; Carlini, Massimo; Carlucci, Michele; Carmichael, Heather; Carrasco, Milagros; Carrillo, Mariana; Carvello, Michele; Casati, Massimiliano; Castoro, Carlo; Catalan, Vanesa; Cavaleiro, Salomé; Cellerino, Paola; Centinaio, Giovanna; Cernei, Cristina; Cerro, Cristina; Cervellera, Maurizio; Chakrabortee, Sohini; Chamberlain, Stephanie; Chan, Jeffrey; Chang, Grace; Chaudhry, Dauod; Chebaro, Alexandre; Chen, David; Chetty, Govind; Chia, Zoe; Chiappini, Ambra; Chiarugi, Massimo; Chidambaram, Swathikan; Chiozza, Matteo; Cholewa, Hanna; Chong, Clara; Choolani-Bhojwani, Ekta; Christoforidis, Dimitri; Chui, Karen; Chung, Choyin; Cirillo, Bruno; Citterio, Davide; Clermidi, Pauline; Coccolini, Federico; Colletti, Gaia; Compagnoni, Bruno; Concepción-Martín, Vanesa; Confalonieri, Marco; Connolly, Hannah; Conso, Christel; Conti, Luigi; Cooper, Zara; Corbellin, Carlo; Cordera, Fernando; Corral, Javier; Costa, Marta; Costanzi, Andrea; Cotsoglou, Christian; Cozza, Valerio; Cuming, Tamzin; Curtis, Miles; Cuschieri, Joseph; D'Agruma, Michele; D'Andrea, Giancarlo; Daliya, Prita; Dare, Oliver; Darko, Ebenezer; Day, Andrew; Dehal, Ahmed; Dehart, Dustin; Delgado-Oliver, Eduardo; Denning, Max; Desai, Anant; Desender, Liesbeth; Dester, Sara; Díaz-García, Alberto; Diaz-Peña, Patricia; Dousset, Bertrand; Doussot, Alexandre; Duchateau, Nicolas; Duff, Sarah; Dunning, Joel; Duque-Mallen, Victoria; Dziakova, Jana; Egan, Bridget; Egan, Richard; El-Ali, Abess; Elfeki, Hossam; Elhadi, Muhammed; Eljareh, Mohammed; Elkadi, Hannah; Elkady, Ramy; Elkhafeefi, Fatimah; Elmore, Ugo; Elmoslemany, Tarek; Emmerson, Oliver; Enemosah, Ibrahim; English, Camilla; English, William; Ereidge, Simon; Escartin, Jorge; Estaire-Gomez, Mercedes; Evans, Luke; Evans, Jessica; Exley, Rebecca; Fabbri, Nicoló; Falco, Giuseppe; Familiari, Pietro; Fancellu, Alessandro; Farik, Shebani; Farrell, Tony; Fehervari, Matyas; Fell, Adam; Fernandez-Camuñas, Angel; Fernández-Marín, Reyes; Fernández-Martínez, María; Ferrara, Francesco; Ferrari, Guglielmo; Ferrero, Simone; Findlay, Laura; Fiore, Marco; Fiori, Enrico; Flatman, Michael; Flindall, Ian; Flor, Blas; Fontana, Tommaso; Ford, Samuel; Ford, David; Forlani, Stefano; Francone, Elisa; Frattaruolo, Colomba; Frio, Federico; Gagliano, Annalisa; Gagliardi, Filippo; Gahunia, Sukhpreet; Gaino, Francesca; Gala, Tanzeela; Galfrascoli, Elisa; Galimberti, Luca; Gallagher, Phoebe; Galleano, Raffaele; Galván-Pérez, Armando; Gammeri, Emanuele; Ganau, Mario; Garcés-García, Raúl; Garulli, Gianluca; Gascon-Ferrer, Isabel; Gattolin, Andrea; Gaujoux, Sebastien; Gentilli, Sergio; Georgiades, Fanourios; Ghanbari, Amir; Ghosh, Dhruv; Giacometti, Marco; Giblin, Anna-Victoria; Gilbert, Catherine; Giménez, Clara; Giorgakis, Emmanouil; Gipponi, Manuel; Glen, Paul; Goatly, Giles; Gobatti, Davide; Godbole, Chintamani; Gohil, Kajal; Gómez, Marcos; Gomez-Rosado, Juan-Carlos; Gonullu, Emre; Gonzalez-Gonzalez, Enrique; Gordini, Luca; Gracia, Isabel; Gracia-Roche, Carlos; Granieri, Stefano; Green, Susanna; Grivon, Manuela; Grove, Thomas; Guaglio, Marcello; Guaitoli, Eleonora; Guglielmi, Alfredo; Guha, Soumya; Gustavino, Claudio; Habeeb, Amir; Hagger, Robert; Hakmi, Hazim; Halkias, Constantine; Hall, Claire; Hampton, Matthew; Handa, Siddhartha; Hansen, Laura; Haq, Iram; Harky, Amer; Harries, Rhiannon; Harrison, Joseph; Hasan, Raashad; Hawari, Mohammad; Hawkin, Paul; Hebblethwaite, Bethany; Henriques, Susana; Heritage, Emily; Hernandez-Juara, Pilar; Herrero-Lopez, Maria; Hervieux, Erik; 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Landaluce-Olavarria, Aitor; Lapolla, Pierfrancesco; Lawani, Ismail; Lawday, Samuel; Lázaro, André; Lecolle, Katia; Leventoglu, Sezai; Li, Zoe; Liew, Ignatius; Lisi, Giorgio; Lizzi, Vincenzo; Lo, Terence; Lomiento, Daniele; Longhi, Marco; Lostis, Emilie; Lostoridis, Eftychios; Loubani, Mahmoud; Lowy-Benoliel, Alejandro; Lucianetti, Alessandro; Luke, Louis; Lunevicius, Raimundas; Luraghi, Marco; Lye, George; Mabrouk, Islam; Macchi, Alberto; MacDonald, Luisa; Machairas, Nikolaos; Madonini, Marco; Magowan, Drew; Maisonneuve, Emeline; Majkowska, Agata; Majkowski, Lawrence; Mak, Jason; Malabarba, Stefano; Malerba, Michele; Mannan, Syed; Manson, Joanna; Mansuri, Ahmer; Mantoglu, Baris; Manu, Nichola; Maqsood, Afnan; Marano, Alessandra; Marchbank, Adrian; Marcos-Santos, Pablo; Marrano, Enrico; Martin, Janet; Martin, Emmeline; Martin, Guy; Martin-Albo, Lorena; Martín-Román, Lorena; Martinelli, Fabio; Martínez-dePaz, Fernando; Martinez-German, Antonio; Martinez-Pinedo, Carlos; Martins, Ricardo; Marwan, Hisham; Marzi, Federica; Mateos-Sierra, Olga; Mathieu, Pierre; Matute-Najarro, Maria-Soledad; Maw, Andrew; Mazingi, Dennis; Mazzaferro, Vincenzo; McCanny, Andrew; McKenzie, Katherine; McLarty, Nicola; McPherson, Iain; Medina, Esther; Mediratta, Saniya; Medone, Marzia; Mehra, Gautam; Mele, Simone; Melero-Cortés, Lidia; Mendoza-Moreno, Fernando; Meneghini, Simona; Mercante, Giuseppe; Merdrignac, Aude; Merola, Stephen; Metallidis, Symeon; Michel, Martin; Migliore, Marco; Mihanovic, Jakov; Miller, Douglas; Mingoli, Andrea; Minto, Gary; Mirabella, Antonello; Misra, Nikhil; Mitrasinovic, Stefan; Miu, Victor; Moawad, Nader; Mochet, Sylvie; Modabber, Ali; Mohammad, Adam; Mohan, Midhun; Moliner-Sánchez, Carmen; Mongelli, Francesco; Monteleone, Michela; Montuori, Mauro; Moore, Rachel; Mora-Guzmán, Ismael; Morales, Xavier; Morales, Dieter; Morelli, Luca; Morelli, Lucia; Morgan, Richard; Morris, Chris; Mortini, Pietro; Mosca, Angelo; Motter, Dema; Moug, Susan; Mukherjee, Samrat; Najdy, Manhal; Nakas, Apostolos; Namazov, Ilgar; Naredla, Pradyumna; Nasef, Emmhamed; Nassa, Heeam; Nath, Rahul; Navarro-Sánchez, Antonio; Nazarian, Scarlet; Negri, Giampiero; Nehra, Deepika; Neil-Dwyer, Jason; Neri, Jacopo; Newton, Katy; Nikaj, Herald; Niquen, Milagros; Nobile, Sara; Nogueiro, Jorge; Ntirenganya, Faustin; Nugent, Michael; Núñez, Jordi; Ocaña, Juan; Okechukwu, Valentine; Oliva-Mompean, Fernando; Oliveira, Ana; Ollat, Didier; Onos, Lavinia; Osagie-Clouard, Liza; Osman, Khabab; Ottolina, Jessica; Ourieff, Jared; Outani, Oumaima; Oyewole, Bankole; Ozben, Volkan; Pacheco-Sanchez, David; Padilla-Valverde, David; Pai, Madhava; Paiella, Salvatore; Paisley, Samuel; Palini, Gianmarco; Palmeri, Matteo; Panahi, Pedram; Parente, Alessandro; Parlanti, Daniele; Parmar, Chetan; Pascual, Angela; Patel, Mahul; Pathak, Abhijit; Patil, Sangram; Pattyn, Piet; Peckham-Cooper, Adam; Pedrazzani, Corrado; Pellino, Gianluca; Peluso, Chiara; Pereira, André; Pereira-Neves, António; Perez-Diaz, Md; Pérez-González, Marta; 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[10.1016/S0140-6736(20)31182-X]

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Gallo, Gaetano;Pata, Francesco;DI Bartolomeo, Alessandro;Cicerchia, Pierfranco M;Fonsi, Giovanni B;De Toma, Giorgio;La Torre, Filippo;Bàmbina, Fabrizio;Brachini, Gioia;Chiappini, Ambra;Cirillo, Bruno;Familiari, Pietro;Fiori, Enrico;Iannone, Immacolata;Lapolla, Pierfrancesco;Meneghini, Simona;Mingoli, Andrea;Santoro, Antonio;Sapienza, Paolo;Zambon, Martina;Bruzzaniti, Placido
2020

Abstract

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 82·6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28-2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65-3·22], p<0·0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2·35 [1·57-3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01-2·39], p=0·046), emergency versus elective surgery (1·67 [1·06-2·63], p=0·026), and major versus minor surgery (1·52 [1·01-2·31], p=0·047). Interpretation: Postoperative 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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1405764
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