Why it’s safer to postpone elective surgery

Lancet reports higher post-operative mortality rate among COVID-19 patients

Being cautious: Hospitals have told patients to postpone some surgeries during the COVID-19 pandemic.

Patients with the SARS CoV-2 infection, who undergo surgeries, are at an increased risk of mortality, says a newly published study in the medical journal Lancet . Researchers studied data of 1,128 patients from 235 hospitals across the world and found that the 30-day mortality in such patients was nearly 23.8%, which is much greater than the numbers seen in high-risk patients before the pandemic.

The study carried out by experts from University of Birmingham included patients undergoing surgery who had SARS-CoV-2 infection diagnosed within seven days before or 30 days after surgery. Their surgeries were carried out between January 1 and March 31.

“Post-operative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality,” the study identified further, adding that post-operative outcomes in such patients are substantially worse than pre-pandemic baseline rates of pulmonary complications and mortality.

While overall 30-day mortality in the study was 23.8%, it also showed that mortality was higher among men and patients above the age of 70. Mortality in other subgroups was also high: 18.9% in elective surgery patients, 25.6% in emergency patients, 16.3% in those who underwent minor procedures and 26.9% in those who underwent major procedures.

“We would normally expect mortality for patients having minor or elective surgery to be under 1%,” co-author Aneel Bhangu was quoted as saying in a press release by the University of Birmingham.

“These mortality rates are greater than those reported for even the highest-risk patients before the pandemic; for example, the 2019 UK National Emergency Laparotomy Audit reported 30-day mortality of 16.9% in the highest-risk patients, and a previous study across 58 countries reported a 30-day mortality of 14.9% in patients undergoing high-risk emergency surgery,” he added.

Going by the global experience, medical experts in India have been treading cautiously, by postponing elective surgeries and managing patients with conservative treatment. At KEM Hospital, one of the largest public hospitals in Mumbai, all elective surgeries have been postponed but an average of eight emergency procedures including Caesarean sections, laparotomies, fixing compound fractures etc. are being carried out.

“In patients with the SARS CoV-2 infection, the postoperative complications are much higher and thus the mortality is high too,” said hospital’s Dean, Dr. Hemant Deshmukh.

Dr C. Pramesh, director of the Tata Memorial Hospital said it takes about 10 days for a COVID-19 patient to turn negative and it is wise to wait till then to operate.