This study, published very early this Saturday, May 30, 2020 in the reference journal The Lancet, is likely to be talked about a lot. It was initiated by the CovidSurg group, which is made up of international surgeons whose goal is to conduct large-scale studies to improve surgical practices worldwide
says Dr. Alexis Arnaud, visceral surgeon at Rennes South Hospital, CovidSurg referent in France and co-author of the study.
With the arrival of the Covid-19 epidemic, we decided to see if this virus had an impact on surgical management. So we have, from 1er January started including patients from Europe. In total, we studied 1,128 patients from 235 hospitals in 24 countries.
A sufficiently representative panel with conclusions that surprised their authors.
We have found that patients operated on after contracting coronavirus infection have a much increased risk of postoperative death
reveals Dr Alexis Arnaud. A risk estimated at nearly 24% while the average postoperative death rate hovers around 3%. A risk therefore multiplied by a factor of 8.
Abnormally high mortality
COVID-19 infected patients who are operated on have significantly worse postoperative outcomes than would be expected for similar patients without coronavirus infection
continues Dr. Arnaud. The overall 30-day mortality in the study was 23.8% and this mortality was abnormally increased in all the subgroups
.
Almost 18.9% in scheduled surgery, 25.6% in emergency surgery, 16.3% in minor surgery such as appendectomy or hernia repair. 26.9% in major surgery such as hip surgery or colon cancer surgery…
The study also identified that the mortality rate was higher in men (28.4%) than in women (18.2%), and in patients over 70 years (33.7%) by compared to patients under 70 (13.9%).
Pulmonary complications
How do the authors analyze these results? Patients may be particularly susceptible to subsequent pulmonary complications due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation
thinks Professor Aneel Banghu of the University of Birmingham.
Within 30 days of the procedure 51% of patients develop pneumonia, acute respiratory distress syndrome or require unplanned mechanical ventilation. 81.7% of patients who died had pulmonary complications.
Tests before operating?
Hence their conclusions and recommendations. Non-critical surgery should be postponed during the COVID-19 epidemic and urgent investment is needed to improve the safety of surgical procedures
says Dr. Alexis Arnaud.
Men over the age of 70 undergoing urgent intervention have a particularly high risk of death in this context, which is why, as far as possible, it would be preferable for these patients to have their intervention delayed.
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