Postoperative mortality and complications in patients with and without preoperative SARS-CoV2 infection: A service evaluation of 24 million linked records using OpenSAFELY

• Published in: Anaesthesia Vol. 78; no. 6; pp. 692 - 700
• Main Authors: McInerney, C. D., Kotzé, A., Bacon, S., Cutting, J. E., Fisher, L., Kua, J., McGuckin, D., Mehrkar, A., Goldacre, B., Johnson, O.A., Moonesinghe, S.R.
• Format: Journal Article
• Language: English
• Published: 23-03-2023
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.16001

Surgical decision making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity, and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogenous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English National Health Service (NHS) from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients with seven weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30-day, 6-month), and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most-recent indication of SARS-CoV-2 infection and subsequent surgery.
In any 6-month window, less than 3% of surgical procedures were conducted within seven weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within two weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1·1%, declining to 0·3% by four weeks. Compared to the COVIDSurg study cohort, outcomes for patient in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within seven weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients’ overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.