Episode 10 - General Surgery: Part 2 - Peri-Operative COVID-19 Infection
Play • 37 min

Theme
General Surgery


Participants

Dr Michael Haddock (ED consultant), Dr Sergei Tsakanov (general surgical Fellow), Sunny Rajput (ED trainee), Edgardo Solis (general surgical registrar), Andy Chen (general surgical registrar), Shreyas Iyer, Samoda Wilegoda Mudalige, Kit Rowe, Caroline Tyers, Harry Hong and Yelise Foon. 


Discussion:
Nepogodiev, D., Bhangu, A., Glasbey, J., Li, E., Omar, O., & Simoes, J. et al. (2020). Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet, 396(10243), 27-38. https://doi.org/10.1016/s0140-6736(20)31182-x. 

Summary:

  • This was a cohort study extending over 24 countries hit by the initial COVID-19 pandemic, conducted from January 1st to March 31st 2020.
  • The aim of the study was to evaluate the effect of COVID-19 infection on post-operative recovery, with particular focus on 30-day mortality and pulmonary complication rates in patients with peri-operative COVID-19 infection.
  • 1128 patients were included in the study, with 74% undergoing emergency surgery and 24% having elective surgery.
  • 294 patients had a pre-operative diagnosis and 806 had a post-operative diagnosis of COVID-19. 
  • 30-day mortality for the cohort overall was 23.8%.
  • Post-operative pulmonary complications occurred in half of the patients with peri-operative COVID-19 infection and were associated with significantly higher mortality.
  • This can be compared with data suggesting a pre-pandemic post-operative pulmonary complication rate of only 10% and 30-day mortality of up to 3%.
  • Even in those patients undergoing elective procedures, the mortality rate was 18.9%.

 Take-Home Points:

  • This data suggests that a diagnosis of peri-operative COVID-19 carries significant risk for higher rates of mortality and pulmonary complications. 
  • This supports current practice within Australia where elective surgeries are not taking place. 
  • However, as this pandemic continues to evolve and potentially becomes a part of the ‘new normal’, guidelines surrounding both emergency and elective surgery will need to be further developed and finessed.


Interlude:
Virtual Ward Rounds:
- https://open.spotify.com/show/5K2TdBc35lh77oWJFHWOuh

Credits:
This episode was produced by the Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. 



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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.


~

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