The impact of the COVID-19 pandemic on perioperative safety and surgical activity

Nepogodiev, Dmitri ORCID: https://orcid.org/0000-0002-2171-2862 (2023). The impact of the COVID-19 pandemic on perioperative safety and surgical activity. University of Birmingham. Ph.D.

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Abstract

Early reports from hospitalised medical patients indicated that severe COVID-19 was associated with high mortality rates. In March 2020 there was no high-quality evidence to inform surgical practice during the pandemic. This thesis reports four studies investigating the impact of the COVID-19 pandemic on perioperative safety and surgical activity.

To characterise the outcomes of surgery in patients with perioperative SARS-CoV-2 infection, an international cohort study of 1,128 patients who underwent surgery during the first COVID-19 wave (January to March 2022) was undertaken. It identified that perioperative SARS-CoV-2 infection was associated with increased risk of both 30-day postoperative pulmonary complications and mortality. These data indicated that whenever possible, surgery should be avoided in patients with acute SARS-CoV-2 infection.

To determine the optimal timing of surgery following SARS-CoV-2 infection an international, prospective cohort study was undertaken. This included 140,231 patients in October 2020. Whereas patients operated 0–2 weeks, 3–4 weeks, and 5–6 weeks after a SARS-CoV-2 diagnosis were at increased risk of adverse events, patients operated ≥7 weeks after SARS-CoV-2 diagnosis were not at increased risk compared to patients who had not had a SARS-CoV-2 infection. Subsequent to this study SARS-CoV-2 vaccines were rolled out and the Omicron SARS-CoV-2 variant emerged.

To characterize the applicability of the previous findings to the period of Omicron SARS-CoV-2 variant dominance a further international, prospective cohort study was undertaken to capture surgical outcomes for 19,684 patients with perioperative SARS-CoV-2 infection (December 2021 to February 2022). This found that mortality and 30-day postoperative pulmonary complications had substantially reduced compared to outcomes during the first COVID-19 wave. The findings support initiatives to relax some COVID-19 mitigations measures.

To inform planning of strategies to address pandemic elective care backlogs, the need for elective care in England was modelled and forecast forward to 2030. This estimated that in March 2022 4.3 million people needed elective procedures in England. Even in the most optimistic scenario, 2.6 million people would still be on waiting lists for elective procedures in 2030.

Type of Work:	Thesis (Doctorates > Ph.D.)
Award Type:	Doctorates > Ph.D.
Supervisor(s):	Supervisor(s) Email ORCID Jolly, Kate UNSPECIFIED orcid.org/0000-0002-6224-2115 Lilford, Richard J. UNSPECIFIED orcid.org/0000-0002-0634-984X Morton, Dion UNSPECIFIED orcid.org/0000-0001-6784-1689
Licence:	All rights reserved
College/Faculty:	Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department:	Institute of Applied Health Research
Funders:	National Institute for Health Research
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RD Surgery
URI:	http://etheses.bham.ac.uk/id/eprint/13903

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