Of 1,128 COVID-19 patients undergoing surgery at 235 hospitals in 24 countries, 577 (51.2%) had pulmonary complications, and 219 (38.0%) of them died, according to an observational study published late last week in The Lancet. In the partially retrospective, uncontrolled study, researchers in the COVIDSurg Collaborative enrolled patients 7 days before or 30 days after surgery from Jan 1 to Mar 31. Of the 268 patients who died, 219 (81.7%) had pneumonia or acute respiratory distress syndrome (ARDS) or needed mechanical ventilation. The death rate was highest in patients diagnosed as having ARDS (102 of 162 [63.0%]). Pulmonary complications were associated with high 30-day death rates in patients with a postoperative COVID-19 diagnosis undergoing elective surgery (39 of 138 [28.3%]), a preoperative diagnosis undergoing emergency procedures (53 of 134 [39.6%]), and a postoperative diagnosis undergoing emergency surgery (125 of 290 [43.1%]). Of the 577 patients with one or more pulmonary complications, 456 (40.4%) had pneumonia, 240 (21.3%) needed mechanical ventilation, and 162 (14.4%) had ARDS. At 30 days, 22 of 1,128 patients (2.0%) had had a pulmonary embolism, but the death rate in those patients was similar to those who did not have one. COVID-19 patients undergoing surgery may be vulnerable to lung complications because of related heightened inflammatory and immunosuppressive responses to surgery and mechanical ventilation, the authors said.

 

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