Mortality after surgery with SARS-CoV-2 infection in England: A population-wide epidemiological study

Abbott, T.E.F.; Fowler, A. J.; Dobbs, T. D.; Gibson, J.; Shahid, T.; Dias, P.; Akbari, A.; Whitaker, I. S.; Pearse, R. M.

Background The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative SARS-CoV-2 infection and associated mortality after surgery. Methods Analysis of routine electronic health record data from National Health Service (NHS) hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between 1st January 2020 and 28th February 2021. The exposure was SARS-CoV-2 infection defined by ICD-10 codes. The primary outcome measure was 90-day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson co-morbidity index, index of multiple deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals. Results We identified 2,666,978 patients undergoing surgery of whom 28,777 (1.1%) had SARS-CoV-2 infection. In total, 26,364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6,153/28,777 [21.4 %] vs No SARS-CoV-2: 20,211/2,638,201 [0.8%]; OR: 5.7 [95% CI: 5.5 – 5.9]; P<0.001). Amongst patients undergoing elective surgery 2,412/1,857,586 (0.1%) had SARS-CoV-2 of whom 172/2,412 (7.1%) died, compared with 1,414/1,857,586 (0.1%) patients without SARS-CoV-2 (OR: 25.8 [95% CI: 21.7 - 30.9]; P<0.001). Amongst patients undergoing emergency surgery 22,918/582,292 (3.9%) patients had SARS-CoV-2, of whom 5,752/22,918 (25.1%) died compared with 18,060/559,374(3.4%) patients without SARS-CoV-2 (OR: 5.5 [5.3 – 5.7]; P<0.001). Conclusions The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.