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dc.contributor.authorSTARSurg Collaborative
dc.contributor.authorCOVIDSurg Collaborative
dc.date.accessioned2022-10-11T16:45:02Z
dc.date.available2022-10-11T16:45:02Z
dc.date.issued2021-11-13
dc.identifier.citationSTARSurg Collaborative & COVIDSurg Collaborative 2021 , ' Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic ' , British Journal of Surgery , vol. 108 , no. 12 , pp. 1448–1464 . https://doi.org/10.1093/bjs/znab336
dc.identifier.issn0007-1323
dc.identifier.otherPURE: 31953520
dc.identifier.otherPURE UUID: 31fa3239-2dc1-49ee-86c5-eb1241aa0c9c
dc.identifier.otherScopus: 85122068088
dc.identifier.urihttp://hdl.handle.net/2299/25809
dc.description© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (https://creativecommons.org/licenses/by-nc/4.0/).
dc.description.abstractBackground: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P ¼ 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infectionen
dc.format.extent18
dc.language.isoeng
dc.relation.ispartofBritish Journal of Surgery
dc.titleDeath following pulmonary complications of surgery before and during the SARS-CoV-2 pandemicen
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionExtracellular Vesicle Research Unit
dc.contributor.institutionDepartment of Clinical, Pharmaceutical and Biological Science
dc.contributor.institutionSchool of Life and Medical Sciences
dc.description.statusPeer reviewed
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1093/bjs/znab336
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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