key: cord-0914886-4azftbqg
authors: Agrawal, Vikesh; Sharma, Dhananjaya
title: “Comment on the article titled “Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14 798 procedures” by Elliott JA et al.
date: 2020-12-28
journal: Br J Surg
DOI: 10.1093/bjs/znaa102
sha: bcc27d4c17921171de38e5bc8851bd8849b1d181
doc_id: 914886
cord_uid: 4azftbqg

Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality assumes great importance given the gradual re-booting of elective surgeries all over the world. It is interesting to see that laparoscopic surgery may be protective for nosocomial transmission of COVID-19 infection owing to reduced duration of hospital stay. For the same reason, the wider application of enhanced recovery after surgery protocols need to be explored. Additionally, now there is a definite need to differentiate COVID-specific deaths (deaths due to complications of COVID-19) from the COVID-related deaths (deaths due to complications of comorbidity or the surgical disease or surgery itself in a COVID-19 positive patient). This is required to identify the real risk of nosocomial infection and the subsequent mortality in elective surgery during this pandemic.

We read with interest the article titled "Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14 798 procedures" by Elliott et al. 1 However, we would like to make a few observations. Laparoscopic surgery (LS) had become an early unsung collateral victim of the COVID-19 pandemic due to the 'fear' of COVID-19 infection for health care professionals. This was because of the theoretical potential of virus transmission via surgical smoke and laparoscopy gas, and LS was quickly and somewhat prematurely labeled as a high-risk procedure. So it is very interesting to see that things have come full circle as authors' projections show that LS may be protective for nosocomial transmission of COVID-19 infection owing to reduced duration of hospital stay.

As the end of the pandemic is nowhere in sight, any intervention reducing the duration of hospital stay assumes even greater importance than before. Hence, enhanced recovery after surgery protocols need to be explored for their wider application in these difficult times.

Mortality after surgery in a COVID-19 positive patient so far has been considered as a COVID-19 death irrespective of the severity of the surgical disease, procedure, or associated comorbidity, a definition which can be epidemiologically justified during a pandemic. However, now there is a definite need to differentiate COVID-specific deaths (deaths due to complications of COVID-19) from the COVID-related deaths (deaths due to complications of comorbidity or the surgical disease or surgery itself in a COVID-19 positive patient). This is required to identify the real risk, unlike the theoretical estimations, of nosocomial infection, and the subsequent mortality in elective surgery during this pandemic.

Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14 798 procedures

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