Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study / Nepogodiev, Dmitri; C Glasbey, James; Li, Elizabeth; Omar, M Omar; FF Simoes, Joana; EF Abbott, Tom; Alser, Osaid; P Arnaud, Alexis; K Bankhead-Kendall, Brittany; A Breen, Kerry; F Cunha, Miguel; H Davidson, Giana; Di Saverio, Salomone; Gallo, Gaetano; A Griffiths, Ewen; R Gujjuri, Rohan; J Hutchinson, Peter; MA Kaafarani, Haytham; Lederhuber, Hans; W Löffler, Markus; N Mashbari, Hassan; Minaya-Bravo, Ana; G Morton, Dion; Moszkowicz, David; Pata, Francesco; Tsoulfas, George; L Venn, Mary; Omar M Omar, Aneel Bhangu.; Siaw-Acheampong, Kwabena; Chaudhry, Daoud; E Dawson, Brett; P Evans, Jonathan; C Glasbey, James; R Gujjuri, Rohan; Heritage, Emily; S Jones, Conor; K Kamarajah, Sivesh; Khatri, Chetan; M Keatley, James; Lawday, Samuel; Li, Elizabeth; C Mckay, Siobhan; Nepogodiev, Dmitri; Pellino, Gianluca; Tiwari, Abhinav; M Trout, Isobel; L Venn, Mary; JW Wilkin, Richard; Adamina, Michel; O Ademuyiwa, Adesoji; Agarwal, Arnav; Alameer, Ehab; Alderson, Derek; Alakaloko, Felix; Alser, Osaid; P Arnaud, Alexis; Magne Augestad, Knut; K Bankhead-Kendall, Brittany; Barlow, Emma; A Benson, Ruth; Blanco-Colino, Ruth; Brar, Amanpreet; MinayaBravo, Ana; A Breen, Kerry; Lima Buarque, Igor; J Caruana, Edward; Chakrabortee, Sohini; Cox, Daniel; F Cunha, Miguel; H Davidson, Giana; Desai, Anant; Di Saverio, Salomone; D Drake, Thomas; G Edwards, John; Elhadi, Muhammed; Farik, Shebani; Fiore, Marco; Edward Fitzgerald, J; Ford, Samuel; Gallo, Gaetano; Ghosh, Dhruv; Mendonça Ataíde Gomes, Gustavo; A Griffiths, Ewen; Halkias, Constantine; M Harrison, Ewen; J Hutchinson, Peter; Isik, Arda; D Jenkinson, Michael; MA Kaafarani, Haytham; Kolias, Angelos; Lawani, Ismail; Lederhuber, Hans; Leventoglu, Sezai; W Löffler, Markus; Martin, Janet; N Mashbari, Hassan; Mazingi, Dennis; Metallidis, Symeon; Minaya-Bravo, Ana; M Mohan, Helen; Moore, Rachel; Moszkowicz, David; Moug, Susan; S Ng-Kamstra, Joshua; Niquen, Milagros; Ntirenganya, Faustin; Outani, Oumaima; Pata, Francesco; D Pinkney, Thomas; Pockney, Peter; Radenkovic, Dejan; Ramos-De la Medina, Antonio; Roberts, Keith; C Roslani, April; Khairy Salem, Hosni; Santos, Irène; Schache, Andrew; A Schnitzbauer, Andreas; Sharma, Neil; Shaw, Richard; Shu, Sebastian; Soreide, Kjetil; Spinelli, Antonino; D Stewart, Grant; Sundar, Sudha; Tabiri, Stephen; Townend, Philip; Tsoulfas, Georgios; H van Ramshorst, Gabrielle; Vidya, Raghavan; Vimalachandran, Dale; J Warren, Oliver; Wright, Naomi; EuroSurg, ; Society of Coloproctology (ESCP), European; GlobalPaedSurg, GlobalSurg; PTSurg, ItSURG; SpainSurg, ; Society of Colorectal Surgery (SICCR), Italian; of Surgeons in Training (ASiT), Association; Elgun Samadov, Irish Surgical Research Collaborative (ISRC). Faraj S Almaadany (Établissement Hospitalier Spécialisé en Cancérologie - Centre Pierre-etMarie-Curie).; Namazov, Ilgar; Gabrielle H van Ramshorst, Sevda Jafarova (Leyla Medical Center).; Pattyn, Piet; Desender (Ghent University Hospital), Liesbeth; A de Gheldere, Charles; Jakov Mihanovic, Nicolas Duchateau (Heilig Hart Ziekenhuis Lier).; Sulen, Nina; Andabaka, Tatjana; Rakvin, Ivan; Henry G Smith, Bernarda Bakmaz (Zadar General Hospital).; L Jönsson (Bispebjerg Hospital, Maria; Mohamed El Kassas, University of Copenhagen).; Tawheed (Endemic Medicine Department, Ahmed; University), Helwan; Shehata, Sameh; M Ashoush, Fouad; S Abdelaal (Alexandria Main University Hospital), Ahmed; Cairo University), Mahmoud MA Elfiky (Kasr Alainy Faculty of Medicine; H Emile, Sameh; H Elfallal, Ahmed; Elfeki, Hossam; Shalaby (Mansoura University Hospital), Mostafa; M Alrahawy (Menofiya University Hospital), Mahmoud; Gamal Amira, Ibrahim Sallam; Sherief, Ahmed; Zaher Lakkis, Mohamed Sherief (MISR Cancer Center/MISR International Hospital).; Doussot, Alexandre; Turco, Celia; Heyd, Bruno; Mathieu (CHU Besançon), Pierre; Chebaro, Alexandre; Lecolle, Katia; Zerbib, Philippe; Truant, Stéphanie; Saudemont, Alain; Pruvot (Lille University Hospital), François-René; P Arnaud, Alexis; Bergeat, Damien; Merdrignac (Rennes University Hospital), Aude; Scalabre, Aurelien; Le Roy, Bertrand; Perotto (CHU Saint Etienne), Ornella; Tzedakis, Stylianos; Gaujoux, Sebastien; - AP-HP), Bertrand Dousset (Hôpital Cochin; Frédéric Bretagnol (Hôpital Louis-Mourier - GHU AP-HP. Nord - Université de Paris), David Moszkowicz; Hervieux, Erik; Maisonneuve, Emeline; Clermidi, Pauline; Aubry, Emmanuelle; - APHP), Anne Thomin (Hôpital Trousseau; Seguin-Givelet, Agathe; Zadegan, Frederic; Conso, Christel; Carsten Kamphues, Didier Ollat (Institut Mutualiste Montsouris).; C Lauscher, Johannes; Schineis (Charité University Medicine, Christian; Benjamin Franklin), Campus; A Schnitzbauer, Andreas; Thoenissen, Philipp; El Youzouri, Hanan; Schreckenbach, Teresa; A Nguyen (Frankfurt University Hospital, Truong; University), Goethe; Modabber, Ali; Hölzle, Frank; Winnand (University Hospital Aachen), Philipp; Königsrainer, Alfred; Quante, Markus; Yurttas, Can; Konstantinos Bouchagier, Markus W Löffler (University Hospital Tübingen).; Klimopoulos (Evangelismos General Hospital), Serafeim; Tzovaras, George; Baloyiannis, Ioannis; Perivoliotis (General University Hospital of Larissa), Konstantinos; Lostoridis, Eftychios; Arnold DK Hill, Paraskevi Tourountzi (Kavala General Hospital).; A De Marchi, Joshua; Farrell, Tony; F Davis, Niall; Kearney (Beaumont Hospital), David; O Larkin, John; M Mohan, Helen; J Mehigan, Brian; A Fahey, Brian; James's Hospital), Conor P Barry (St.; A Elliott, Jessie; A Bass, Gary; M Connelly, Tara; O Kavanagh, Dara; Elkady, Ramy; C Neary, Paul; F Ridgway, Paul; P Joyce, Doireann; Tierney, Sean; Boyle, Emily; Egan (Tallaght University Hospital), Bridget; J Lowery, Aoife; G Collins, Chris; Hogan, Aisling; L McKevitt, Kevin; J Ryan, Éanna; L Fowler, Amy; M Aherne, Thomas; Nizami, Kulsoom; Oded Zmora, Stewart Walsh (Galway University Hospital).; Maurizio Zizzo, Nadav Kugler (Shamir Medical Center).; Falco, Giuseppe; Castro Ruiz, Carolina; Mele, Simone; Annessi, Valerio; Ferrari, Guglielmo; T Montella (Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia), Maria; Andrea Pisani Ceretti (ASST Santi Paolo e Carlo), Nicolò M Mariani; Lomiento, Daniele; Taglietti, Lucio; Del Giudice, Roberto; Compagnoni, Bruno; Dester (ASST Valcamonica Ospedale di Esine), Sara; Christian Cotsoglou (ASST Vimercate), Stefano Granieri; Campagnaro, Tommaso; Turri, Giulia; Guglielmi, Alfredo; Ruzzenente, Andrea; Pedrazzani, Corrado; Salvia, Roberto; Paiella, Salvatore; Nobile (Azienda Ospedaliera Universitaria Integrata di Verona), Sara; V Marino, Marco; Mirabella, Antonello; Vaccarella (Azienda Ospedaliera, Gianpaolo; Riuniti Villa Sofia-Cervello, Ospedali; Palermo), ; Francone, Elisa; Gentilli, Sergio; Nikaj (Azienda Ospedaliero Universitaria Maggiore della Carità, Herald; Novara), ; Morelli, Luca; Di Franco, Gregorio; Palmeri, Matteo; Tartaglia, Dario; Coccolini, Federico; Chiarugi (Azienda Ospedaliero Universitaria Pisana), Massimo; Anania, Gabriele; Chiozza, Matteo; Urbani (Azienda Ospedaliero Universitaria San'Anna, Alessia; Ferrara), ; Adolfo Pisanu (Cagliari University Hospital), Mauro Podda; Porcu, Alberto; Perra, Teresa; Fancellu, Alessandro; Familiari, Pietro; D'Andrea, Giancarlo; Bàmbina (Fabrizio Spaziani Hospital, Fabrizio; Frosinone), ; Fiore, Marco; Macchi, Alberto; Citterio, Davide; Mosca, Angelo; Martinelli, Fabio; Rolli, Luigi; Guaglio, Marcello; V Comini, Lara; Capizzi, Vita; Mazzaferro (Fondazione IRCCS Istituto Nazionale dei Tumori, Vincenzo; Milan), ; Cozza, Valerio; Gordini, Luca; P Lombardi, Celestino; De Simone, Veronica; Marzi, Federica; A Marra (Fondazione Policlinico Universitario Agostino Gemelli), Angelo; Baldini, Edoardo; Conti, Luigi; Ribolla, Marta; M Isolani, Simone; da Saliceto”, Patrizio Capelli (Ospedale “G.; Piacenza), ; Spinelli, Antonino; Carvello, Michele; Di Candido, Francesca; Kurihara, Hayato; Marrano, Enrico; Torzilli, Guido; Castoro, Carlo; Da Roit, Anna; Mercante, Giuseppe; Spriano, Giuseppe; Gaino, Francesca; – IRCCS, Armando De Virgilio (Humanitas Clinical and Research Center; Rozzano), ; Bonavina, Luigi; Asti (IRCCS Policlinico San Donato, Emanuele; of Milan), University; V Feo, Carlo; Fabbri, Nicoló; Righini (Ospedale del Delta, Erminio; Unità Sanitaria Locale di Ferrara, Azienda; of Ferrara), University; Di Saverio, Salomone; Di Saverio, Salomone; Scorza, Antonella; Iovino, Domenico; Carcano (Ospedale di Circolo, Giulio; of Insubria, University; Hospital of Varese, University; Sette Laghi, Asst; Lombardia), Regione; Baldi, Caterina; M Sampietro, Gianluca; - ASST Rhodense), Carlo Corbellini (Ospedale Di Rho; Cellerino, Paola; A Zappa, Marco; Ardito, Antonella; Galfrascoli, Elisa; e Oftalmico), Giulio Iacob (Ospedale Fatebenefratelli; Zanini, Nicola; Palini, Gianmarco; Garulli (Ospedale Infermi di Rimini), Gianluca; Ballabio, Michele; Bisagni, Pietro; Pizzini, Paolo; Gagliano, Annalisa; Armao, Teodora; Longhi, Marco; Madonini, Marco; Luraghi, Marco; Galimberti, Luca; Romano, Silvio; Bastazza, Marco; Trotta, Francesco; Gipponi, Manuel; Malabarba, Stefano; Centinaio (Ospedale Maggiore di Lodi), Giovanna; Mochet, Sylvie; Morelli, Lucia; Usai, Antonella; Grivon, Manuela; Barmasse (Ospedale Regionale Umberto Parini), Roberto; Luigi MP Marino Cosentino (PO San Filippo Neri - ASL ROMA 1), Andrea Sagnotta; Galleano, Raffaele; Malerba, Michele; Baldo (Ospedale Santa Corona, Stefano; Ligure (SV), Pietra; Casati, Massimiliano; Abate, Emmanuele; Laface (Ospedale Vittorio Emanuele III, Letizia; Brianza), Carate; Lizzi, Vincenzo; Vovola, Fernanda; Arminio (Ospedali Riuniti Azienda Ospedaliera Universitaria Foggia), Armando; Vergari (Ospedali Riuniti di Ancona), Roberto; Rausa, Emanuele; Bianco, Federica; Lucianetti (Papa Giovanni XXIII Hospital), Alessandro; Guaitoli (Perrino), Eleonora; Pinotti, Enrico; Carissimi, Francesca; Montuori, Mauro; Baronio (Policlinico San Pietro), Gianluca; Campanelli, Michela; S Sica, Giuseppe; Siragusa (Policlinico Tor Vergata Hospital, Leandro; Rome), ; Lapolla, Pierfrancesco; Mingoli, Andrea; De Toma, Giorgio; Fiori, Enrico; La Torre, Filippo; Sapienza, Paolo; Brachini, Gioia; Cirillo, Bruno; Iannone, Immacolata; Zambon, Martina; Chiappini, Ambra; Meneghini, Simona; B Fonsi, Giovanni; M Cicerchia, Pierfranco; Bruzzaniti, Placido; Santoro, Antonio; I, Alessandro Di Bartolomeo (Policlinico Umberto; University of Rome), Sapienza; Sasia, Diego; Migliore, Marco; Gattolin (Regina Montis Regalis Hospital, Andrea; Mondovì), ; Rottoli, Matteo; Ravaioli, Matteo; Schiavina, Riccardo; Solli, Piergiorgio; Frio (Institute of Neurological Sciences of Bologna, Federico; Bologna), Ausl; Neri, Jacopo; Poggioli, Gilberto; Belvedere, Angela; P Pezzuto, Anna; Parlanti, Daniele; Violante, Tommaso; Tonini, Valeria; Cervellera, Maurizio; Sartarelli (Sant’Orsola Hospital, Lodovico; Mater Studiorum University of Bologna), Alma; Giacometti, Marco; Zonta (Ospedale San Biagio, Sandro; Domodossola, ; VCO), Asl; Ferrara, Francesco; Stella, Marco; Gobatti (San Carlo Borromeo Hospital, Davide; e Carlo, ASST Santi Paolo; Milan), ; Costanzi, Andrea; Confalonieri, Marco; Colletti, Gaia; Frattaruolo, Colomba; Maria Mari, Giulio; Monteleone (Ospedale San Leopoldo Mandic, Michela; Merate, ; Lecco), Asst; Candiani, Massimo; Bonavina, Giulia; Valsecchi, Luca; Ottolina, Jessica; Mortini, Pietro; Gagliardi, Filippo; Piloni, Martina; Medone, Marzia; Carlucci, Michele; Negri, Giampiero; Bandiera, Alessandro; De Nardi, Paola; Elmore, Ugo; Sileri (San Raffaele Scientific Institute, Pierpaolo; Milan), ; Lisi, Giorgio; Carlini, Massimo; Spoletini (Sant'Eugenio Hospital), Domenico; Carmela Giuffrida, Maria; Borghi, Felice; Rosato, Francesco; Puppo, Andrea; D'Agruma, Michele; Marano, Alessandra; Testa, Valentina; e Carle Hospital, Chiara Peluso (Santa Croce; Cuneo), ; Barra, Fabio; Ferrero, Simone; Gustavino (Unit of Obstetrics and Gynecology IRCCS Ospedale Policlinico San Martino Genoa), Claudio; Gallo, Gaetano; Sammarco, Giuseppe; Trompetto, Mario; Vescio (University 'Magna Graecia' of Catanzaro), Giuseppina; Fontana (Vittorio Emanuele, Tommaso; Mahmoud Al-Masri, Gela).; K Abou Chaar, Mohamad; Ghadah Z Alkadeeki, Hani Al-Najjar (King Hussein Cancer Center).; S Al Maadany, Faraj; Nasef, Emmhamed; Elkhafeefi, Fatimah; Eljareh (Aljalaa Hospital), Mohammed; EM Bouhuwaish, Ahmad; SA Taher, Ahmed; B Yousuf (Tobruk Medical Center), Farhat; M Morgom (Tripoli Central Hospital), Marwa; A Salamah, Abdulrauf; A Salama, Hiba; Fernando Cordera, Mustafa R Bulugma (Zawia Teaching Hospital).; Suzanne S Gisbertz, Maria R Alvarez (Sociedad Quirúrgica at the American British Cowdray Medical Center).; BJ Borgstein, Alexander; I van Berge Henegouwen (Amsterdam UMC, Mark; of Amsterdam, University; Center Amsterdam), Cancer; Martine Uittenbogaart (Máxima Medical Center), Wouter KG Leclercq; Kruijff, Schelto; PM de Vries, Jean-Paul; Y van der Plas, Willemijn; J Steinkamp, Pieter; KC Jonker (University Medical Center Groningen (University of Groningen), Pascal; Maarten van Heinsbergen (VieCuri Medisch Centrum), Joop Konsten; Hugo Santos-Sousa, Mariyah Anwer (Jinnah postgraduate medical center).; Cavaleiro, Salomé; M Leite-Moreira, André; Pereira, André; Pereira-Neves, António; S Faria, Carlos; M Monteiro, Joana; Nogueiro, Jorge; Sampaio-Alves, Mafalda; Magalhães Maia, Mariana; e Universitário de São João), Paula Vieira (Centro Hospitalar; Lázaro, André; Martins, Ricardo; Oliveira, Ana; Costa, Marta; e Universitário de Coimbra), Ana C Almeida (Centro Hospitalar; Tobias Teles (Hospital de Cascais - Dr. José de Almeida), Pedro A Serralheiro; Borges, Filipe; João Lima, Maria; Matos Costa, Paulo; 5 Eduardo E Rubio, Susana Henriques (Hospital Garcia de Orta).; A Vivas, Alfredo; A Vega (12 de Octubre University Hospital), Viviana; Navarro-Sánchez, Antonio; Martel Lozano, Saida; Camacho Fernández-Pacheco (Complejo Hospitalario Universitario Insular-Materno Infantil), Borja; Carlos Bernal-Sprekelsen, Juan; MartínezPérez, Carolina; Carlos Catalá Bauset (Consorcio Hospital General Universitario), Juan; TurradoRodriguez, Victor; Morales, Xavier; Gracia, Isabel; Pujol-Muncunill, Roger; Borja De Lacy (Hospital Clinic Barcelona), F; M Muguerza, Jose; Dziakova, Jana; Sanchez del Pueblo, Cristina; B Avellana, Rocio; Catalan, Vanesa; Picazo, Sara; Garcia Fernandez, Andres; L Romera, Jose; L Garcia Galocha, Jose; Rojo, Mikel; J Torres, Antonio; Munoz Rivas, Ana; Camarero, Enrique; Saez, Carlos; Lopez Antonanzas (Hospital Clinico San Carlos, Leyre; Madrid), ; De Andrés-Asenjo, Beatriz; Beltrán de Heredia, Juan; VázquezFernández, Andrea; Trujillo-Díaz, Jeancarlos; Ruiz-Soriano (Hospital Clínico Universitario de Valladolid), María; Minaya-Bravo, Ana; San Miguel Mendez, Carlos; Galván-Pérez, Armando; Robin-Valle, Alvaro; Gonzalez-Gonzalez, Enrique; Calcerrada-Alises, Enrique; Angel Garcia-Ureña (Universidad Francisco de Vitoria, Miguel; Universitario del Henares), Hospital; Carrasco, Milagros; Giménez, Clara; Medina, Esther; J Fernández, Antonio; Ruiz-Marin (Hospital General Universitario Reina Sofía, Miguel; Murcia), ; Estaire-Gomez, Mercedes; Martínez-dePaz, Fernando; Sanchez-Pelaez, Daniel; Jimenez-Higuera, Elisa; Martinez-Pinedo, Carlos; Picon-Rodriguez, Rafael; Fernandez-Camuñas, Angel; Padilla-Valverde (Hospital General Universitario De Ciudad Real), David; Rey-Valcarcel, Cristina; Perez-Diaz, Md; Fernández-Martínez, María; Martín-Román, Lorena; Fanjul Gómez, María; Rio-Gomez, Javier; Tousidonis, Manuel; Alonso-Ortuño, Paula; Ayuso-Herrera, Esther; Martin-Albo, Lorena; Aragon-Chamizo, Juan; Lowy-Benoliel, Alejandro; Quintana-Villamandos, Begoña; Sanchez-Perez, Coral; Mateo-Sierra (Hospital General Universitario Gregorio Marañón), Olga; Corral, Javier; Caballero, Albert; i Pujol), Alba Zarate (Hospital Germans Trias; M Diez-Alonso, Manuel; Mendoza-Moreno, Fernando; VeraMansilla, Cristina; Ruiz-Grande, Fernando; Hernandez-Juara, Pilar; Blazquez-Martin (Hospital Principe De Asturias), Alma; Soto Montesinos, Cristina; J Gómez Díaz, Carlos; A Guariglia, Claudio; Sanchon Fructuoso, Lorena; L Osorio, Alexander; Farré Font, Roser; - Xarxa Assistencial Universitària de Manresa), Pablo Collera Ormazabal (Fundació Althaia; Mora-Guzmán (Hospital Santa Bárbara), Ismael; Serrano González, Javier; Díaz Pérez, David; Ángel Hernández Bartolomé, Miguel; Gutiérrez Samaniego, María; Galindo Jara (Hospital Universitario de Torrejón, Pablo; de Medicina, Facultad; Francisco de Vitoria, Universidad; Madrid), ; Hernandez Garcia, Miguel; Losada Ruiz, Manuel; Dieguez Fernandez, Beatriz; Garcia-Conde Delgado, Maria; Alonso Poza (Hospital Universitario del Sureste), Alfredo; DuqueMallen, Victoria; Gracia-Roche, Carlos; Martinez-German, Antonio; Santero-Ramirez, Maria-Pilar; Matute-Najarro, Maria-Soledad; De Miguel-Ardevines, Maria-Carmen; Sanchez-Fuentes, Maria-Nieves; Saudi-Moro, Sef; Gascon-Ferrer, Isabel; Herrero-Lopez, Maria; Delgado-Oliver, Eduardo; Sanchez-Rubio, Maria; Cantalejo-Diaz (Hospital Universitario Miguel Servet), Miguel; E Pérez-Sánchez, Luis; ConcepciónMartín, Vanesa; Díaz-García (Hospital Universitario Nuestra Señora de Candelaria), Alberto; Ramos, Diego; G Barranquero, Alberto; Ocaña, Juan; Núñez, Jordi; y Cajal), Cristina Cerro (Hospital Universitario Ramón; J Tejero-Pintor, Francisco; Pérez-Saborido, Baltasar; Marcos-Santos, Pablo; Choolani-Bhojwani, Ekta; Acebes-Garcia, Fernando; D Bueno-Cañones, Alejandro; Pacheco-Sanchez, David; BailonCuadrado (Hospital Universitario Río Hortega), Martin; Senent-Boza, Ana; Benítez-Linero, Inmaculada; Ramallo-Solís, Irene; Sánchez-Arteaga, Alejandro; Melero-Cortés, Lidia; Fernández-Marín, Reyes; M Durán-Muñoz-Cruzado (Hospital Universitario Virgen del Rocio), Virginia; Gomez-Rosado, Juan-Carlos; Dolores Del Toro, M; Valdes-Hernandez, Javier; Reguera-Rosal, Julio; Capitan-Morales, Luis-Cristobal; Oliva-Mompean (Hospital Universitario Virgen Macarena), Fernando; Sancho-Muriel, Jorge; Cholewa, Hanna; y Politécnico La Fe), Blas Flor (Hospital Universitario; Landaluce-Olavarria, Aitor; Gonzalez-De Miguel, Melania; Fernández-Gomez Cruzado (Hospital Urduliz), Laura; Jimeno, Jaime; 6 Toledo, Enrique; Pascual, Angela; Carrillo, Mariana; Morales, Dieter; Gómez, Marcos; C Rodriguez-Sanjuan (Marqués de Valdecilla University Hospital), Juan; Melody Baeza (Morales Meseguer University Hospital), José Aguilar; Rey-Biel, Juan; Pingarrón-Martín, Lorena; Moliner-Sánchez, Carmen; RuizMartin (Rey Juan Carlos University Hospital), Irene; Escartin, Jorge; luis Blas Laina, Juan; Nogues Pevidal (Royo Villanova), Ana; T Enjuto, Diego; Ramos-Bonilla, Antonio; Pérez-González, Marta; Diaz-Peña, Patricia; Garcés-García, Raúl; Marqueta De Salas, Maria; Osman M Ali, Elima P Cagigal-Ortega (Hospital Universitario Severo Ochoa).; Dimitri Christoforidis, Ali A Ali karar (Al-rajhi).; Arigoni, Michele; Mongelli, Francesco; Bernasconi, Matteo; Di Giuseppe (Ente Ospedaliero Cantonale del Canton Ticino), Matteo; Adamina, Michel; Volkan Ozben, Georgios Peros (Kantonsspital Winterthur).; Aytac, Erman; Aliyeva (Acibadem Mehmet Ali Aydinlar University, Zumrud; Hospital), Atakent; Kara, Yasin; A Bozkurt, Mehmet; Kocataş (Kanuni Sultan Suleyman Training and Research Hospital), Ali; Altintoprak (Sakarya University Faculty of Medicine), Fatih; Gonullu, Emre; Mantoglu (Sakarya University Research and Educational Hospital), Baris; Richard J Davies, Alp Yildiz (Yildirim Beyazit University Yenimahalle Training and Research Hospital).; Ashcroft, James; J Baker, Olivia; HV Byrne, Matthew; A Coughlin, Patrick; ZE Durst, Alexander; Georgiades, Fanourios; Habeeb, Amir; E Hudson, Victoria; Kolias, Angelos; Luke, Louis; Mitrasinovic, Stefan; Mohan, Midhun; H Murphy, Suzanne; WT Ngu, Albert; R O’Neill, John; Ramzi, Joussi; M Rooney, Siobhan; A Singh, Aminder; Waseem, Saima; Wong (Addenbrooke's Hospital), Ken; Lunevicius, Raimundas; RG Sheel, Andrea; P Jones, Robert; M Nunes, Quentin; L Hughes, Jane; Haq, Iram; Misra, Nikhil; MAS Baig, Mirza; Sundhu (Aintree University Hospital), Matthew; Brendan L Skelly (Altnagelvin Area Hospital), Catherine Rossborough; TA Neely, David; Angelou, Dimitrios; McCanny (Antrim Area Hospital), Andrew; Benjamin Martin (Birmingham Children's Hospital), Max J Pachl; Elaine YL Leung (The Pan Birmingham Gynaecological Cancer Centre), Sudha Sundar; Vashisht, Rajiv; Amalina Che Bakri, Nur; R Jiao, Long; Nazarian (Bupa Cromwell Hospital), Scarlet; J Warren, Oliver; Kontovounisios, Christos; Grove (Department of Colorectal Surgery, Thomas; 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[10.1016/S0140-6736(20)31182-X]

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Alberto Porcu
Membro del Collaboration Group
;
Teresa Perra
Membro del Collaboration Group
;
Alessandro Fancellu
Membro del Collaboration Group
;
2020

Abstract

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11388/244326
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