COVID手术协作组分析了围手术期SARS-CoV-2感染患者的死亡率和肺部并发症。2020年5月29日，《柳叶刀》杂志在线发表了这一成果。

目前急需了解SARS-CoV-2对术后恢复的影响，从而为COVID-19大流行期间和之后的临床决策提供依据。研究组报告了围手术期SARS-CoV-2感染患者的30天死亡率和肺部并发症发生率。

研究组在24个国家/地区的235家医院进行了一项国际性的多中心队列研究，2020年1月1日至3月31日，招募了1128例手术前7天或手术后30天内确诊SARS-CoV-2感染的患者，其中835例（74.0％）进行了急诊手术，280例（24.8％）进行了择期手术。294例（26.1％）患者在术前被确诊为SARS-CoV-2感染。

患者的30天死亡率为23.8％。有51.2%的患者发生了肺部并发症；这些患者的30天死亡率为38.0％，占所有死亡人数的82.6％。在校正后的分析中，关于30天死亡率，男性显著高于女性，年龄为70岁及以上的患者显著高于70岁以下的患者，美国麻醉医师学会分级3–5级显著高于1–2级，恶性显著高于良性或产科诊断，急诊手术显著高于择期手术，以及大手术显著高于小手术。

总之，围手术期SARS-CoV-2感染的患者，约半数发生术后肺部并发症，并与高死亡率相关。应考虑推迟非紧急手术和促进非手术治疗以延迟或避免手术。

附：英文原文

Title: Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

 

Author: Dmitri Nepogodiev, James C Glasbey, Elizabeth Li, Omar M Omar, Joana FF Simoes, Tom EF Abbott, Osaid Alser, Alexis P Arnaud, Brittany K Bankhead-Kendall, Kerry A Breen, Miguel F Cunha, Giana H Davidson, Salomone Di Saverio, Gaetano Gallo, Ewen A Griffiths, Rohan R Gujjuri, Peter J Hutchinson, Haytham MA Kaafarani, Hans Lederhuber, Markus W Lffler, Hassan N Mashbari, Ana Minaya-Bravo, Dion G Morton, David Moszkowicz, Francesco Pata, George Tsoulfas, Mary L Venn, Aneel Bhangu, Daniel Cox, April C Roslani, Felix Alakaloko, Jean-Paul PM de Vries, Mahmoud A Aaraj, Tom EF Abbott, Sarah J Abbott, Mutwakil OM Abdalla, Ahmed S Abdelaal, Adesoji O Ademuyiwa, Thomas M Aherne, Osman M Ali, Ghadah Z Alkadeeki, Ana C Almeida, Mahmoud M Alrahawy, Graeme K Ambler, Ehab Alameer, Stefano M Andreani, Beatriz De Andrés-Asenjo, Leyre Lopez Antonanzas, Salah G Aoun, Fouad M Ashoush, Knut Magne Augestad, Rocio B Avellana, Funbi A Ayeni, John OO Ayorinde, Bheemanakone H Babu, Mirza MAS Baig, Oreoluwa M Bajomo, Olivia J Baker, Markus P Baker, Alexander J Baldwin, Vin Shen Ban, Ryan D Baron, Alberto G Barranquero, Conor P Barry, Alessandro DI Bartolomeo, Gary A Bass, Michael F Bath, H Hunt Batjer, Andrew J Beamish, Ajay P Belgaumkar, Matthew N Bence, Ruth A Benson, Juan Carlos Bernal-Sprekelsen, Anuradha R Bhama, Avi V Bhavaraju, Walter L Biffl, Chris M Blundell, Alexander P Boddy, Alexander BJ Borgstein, David C Bosanquet, Karen D Bosch, Ahmad EM Bouhuwaish, Mehmet A Bozkurt, Collin EM Brathwaite, Benjamin C Brown, Oliver D Brown, Allison K Brown, Igor Lima Buarque, Alejandro D Bueno-Caones, Mustafa R Bulugma, Joshua R Burke, Matthew HV Byrne, Elima P Cagigal-Ortega, Rachael A Callcut, Francesca DI Candido, Michaela E Canova, William J Carlos, Edward J Caruana, Liam D Cato, Andrew B Catton, Andrea Pisani Ceretti, Thomas JG Chase, Francesco Di Chiara, Abeed H Chowdhury, Eric A Chung, Pierfranco M Cicerchia, Ethan CS Clough, Natasha L Coleman, Chris G Collins, Michelle L Collins, Emily T Colonna, Lara V Comini, Tara M Connolly, Patrick A Coughlin, Laura Fernández-Gomez Cruzado, Brian R Davidson, Richard J Davies, Emma J Davies, Niall F Davis, Brett E Dawson, Benjamin JF Dean, Maria Garcia-Conde Delgado, Jose J Diaz, Kathryn E Dickson, Manuel M Diez-Alonso, Jan R Dixon, Matthew J Doe, Thomas D Drake, Frederick T Drake, John P Duffy, Declan FJ Dunne, Naomi JM Dunne, Virginia M Durán-Muoz-Cruzado, Alexander ZE Durst, Nicola J Eardley, John G Edwards, Ahmed H Elfallal, Mahmoud MA Elfiky, Jessie A Elliott, Sameh H Emile, Katy M Emslie, Frederick W Endorf, Jamie L Engel, Diego T Enjuto, Eric W Etchill, Jonathan P Evans, Brian A Fahey, Carlos S Faria, Carlo V Feo

 

Issue&Volume: 2020-05-29

 

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 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 82·6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047).

 

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.

 

DOI: 10.1016/S0140-6736(20)31182-X

 

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext