Surgery during the COVID-19 pandemic

The COVIDSurg Collaborative¹ reported high postoperative mortality (268 [23·8%] of 1128 patients) and pulmonary complications (577 [51·2%]) from patients in 235 hospitals in 24 countries over a 3-month period. This study included patients from countries with high and low prevalence of SARS-CoV-2 and case fatality rates, and it will be interesting to know whether the mortality and pulmonary complications are similar between each country.

This information will have important implications for planning management strategies. Unlike the general population with COVID-19, this study¹ included a large number of patients at high risk of developing pulmonary complications and have undergone emergency surgery (835 [74·0%] of 1128), were at grade 3–5 on the American Society of Anesthesiologists (ASA) scale, had gastrointestinal and general procedures (373 [33·1%]), and had orthopaedic surgery (302 [26·8%]). Can these observations be generalised to patients with low-risk elective surgeries, such as breast and thyroid surgery, which are ASA grade 1–2?

It is important to note that patients (especially those with cancer) who are being denied treatment due to the fear of SARS-CoV-2 infection are at a greater risk of morbidity and mortality as a result of the primary pathology, and delaying surgery for these patients will create a huge backlog for health-care services.² Informed decision making, use of appropriate protective measures by the patients and health-care workers, and careful selection of patients for low-risk elective surgery (especially in regions with low prevalence of SARS-CoV-2 and low case fatality) might therefore aid in providing timely treatment.