O22 Risk of death following pulmonary complications of surgery with and without SARS-CoV-2 infection: a comparative analysis of pre-pandemic and pandemic cohort studies

Abstract Introduction No comparison has been made between the risk of death following pulmonary complications in patients with and without SARS-CoV-2 infection. This study aimed to determine the incidence and impact of pulmonary complications before and during the SARS-CoV-2 pandemic. Method A patient-level comparative analysis of two international prospective cohort studies; conducted pre-pandemic (22 January to 19 October 2019) and during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines were included in analysis. The primary outcome measure was the mortality within 30 days of surgery. Result This study included 7402 patients from 50 countries; 3031 (40.9%) were operated pre-pandemic and 4371 (59.1%) during the pandemic. 5.1% (n = 224/4371) of patients during the pandemic developed a postoperative SARS-CoV-2 infection. Despite selection of lower risk cases during the pandemic, the rates of pulmonary complications pre were similar (6.3% vs 6.9%, P = 0.280). However, the risk of death after surgery was higher during the pandemic (2.0% vs 0.7%, P < 0.001). The population attributable fraction of deaths due to pulmonary complications was 37.7% (95% CI: 15.2–64.7%) pre-pandemic and 66.0% (95% CI: 48.6–79.3%) during the pandemic. The increased mortality was largely attributable to SARS-CoV-2 infection; 68.9% (n = 31/45) of deaths patients with pulmonary complications occurred following SARS-CoV-2 infection. Conclusion Pulmonary complications are the primary driver of death after elective surgery during the pandemic. Care providers must urgently reconfigure surgical services to protect patients from perioperative SARS-CoV-2 infection. Take-home Message Pulmonary complications are the primary driver of death after elective surgery during the pandemic. Care providers must urgently reconfigure surgical services to protect patients from perioperative SARS-CoV-2 infection.