key: cord-0934048-fcw59878
authors: Alderman, Joseph
title: Surgery during the COVID-19 pandemic
date: 2020-11-05
journal: Lancet
DOI: 10.1016/s0140-6736(20)32278-9
sha: 19d71700a6a1b23d64f66e295c127a759990fabd
doc_id: 934048
cord_uid: fcw59878

nan

Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ www.thelancet.com Vol 396 November 7, 2020 e76

The COVIDSurg Collaborative 1 highlights a concerningly high rate of postoperative pulmonary complications and high mortality in a large cohort of perioperative patients with known or highly suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Male patients at high risk (American Society of Anesthesiologists grades 3-5) and those patients undergoing emergency or major surgery fared the worst in terms of 30-day mortality. Cancer surgery was also linked to elevated mortality, although non-urgent procedures might have been postponed during the first COVID-19 pandemic peak, which could have altered the patient mix. The absence of a control group is understandable given the need for efficient reporting, but nonetheless, it limited our understanding of the data. Looking forward to a post-pandemic world, COVID-19 will have become a part of past medical history for many patients. Some patients, especially those with acute respiratory distress syndrome (ARDS), will have received critical care and might be living with severe consequences of COVID-19, requiring long-term rehabilitation. These patients might no longer be infected by SARS-CoV-2, but their lives will still be affected by the virus. The impact that this pandemic will have on perioperative and postoperative risk remains unknown.

Long-term analyses of ARDS related to the severe acute respiratory syndrome coronavirus outbreak in early 2000, and the H1N1 influenza A outbreak in 2009, showed that individuals with ARDS who have lived through these outbreaks had impaired pulmonary function, with worse spirometry, diffusion capacity, functional performance, and radiographic appearance compared with matched controls. [2] [3] [4] Historical cohort studies of all-cause ARDS also described a sustained impaired pulmonary function in these individuals. 5 The COVIDSurg Collabo rative clearly show that surgery during acute SARS-CoV-2 infection generates excess risk. However, the question of when, or whether, this risk normalises again remains unclear. Answering this question will be key for safe planning of elective and emergency surgery in individuals who have had SARS-CoV-2 infection.

I declare no competing interests.

Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK

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

Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors

Long-term bone and lung consequences associated with hospitalacquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study

Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS

What's next after ARDS: long-term outcomes