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Patients who isolate before surgery to avoid COVID-19 more likely to develop lung complications

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Against expectations, patients isolating before surgery (mainly to avoid COVID-19 and its complications) are actually at a 20 per cent increased risk of developing postoperative lung complications compared with patients who do not isolate.

According to a new research published in Anaesthesia (a journal of the Association of Anaesthetists), this goes completely against the current guidance in common use, which mandates isolation before surgery. The University of Birmingham-led GlobalSurg-COVIDSurg Collaborative delivered the study: a global collaboration of over 15,000 surgeons working together to collect a range of data on the COVID-19 pandemic.

A total of 96,454 patients from over 1,600 hospitals across 114 countries were included in this new analysis, and, overall, 26,948 (28 per cent) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0 per cent) patients of which 227 (11.7 per cent) were associated with Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) infection.

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Patients who isolated preoperatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in patients who isolated and those that did not (2.1 per cent versus 2.0 per cent, respectively), pre-operative isolation was associated with a 20 per cent increased risk of postoperative pulmonary complications after adjustment for age, comorbidities, and type of surgery performed. The rate of postoperative pulmonary complications also increased with periods of isolation longer than three days, with isolation of four to seven days associated with 25 per cent increased risk of post-operative lung complications and isolation of eight days or longer associated with a 31 per cent increased risk.

These findings were consistent across various environments were other protective strategies were or were not in place (pre-operative testing and COVID-free pathways), showing that regardless of those other strategies, pre-operative isolation does not seem to protect surgical patients from postoperative pulmonary complications or death.

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Looking at the possible reasons for these unexpected findings, one of the study’s lead authors, Senior Lecturer and Surgeon from the University of Birmingham-led National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, Dr. Aneel Bhangu, said: “Isolation may mean that patients reduce their physical activity, have worse nutritional habits and suffer higher levels of anxiety and depression. These effects in already vulnerable patients may have contributed to an increased risk of pulmonary complications. Further, there is increasing evidence demonstrating that prehabilitation (preconditioning) before surgery improves patient recovery and outcomes. It is possible that isolation may have, therefore, conversely led to patient deconditioning and functional decline, adversely influencing their outcomes.”

Co-lead author and a Research Fellow at the University of Birmingham’s NIHR Global Health Research Unit on Global Surgery, Dr. Joana Simoes, added: “Our evidence suggests that removing pre-operative isolation strategies is unlikely to lead to worse postoperative outcomes for patients, but institutions should monitor their postoperative pulmonary complication rates as strategies evolve.”

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