Global surgery study: Patients who isolate before surgery may have increased postoperative lung complications

In many countries, surgical patients are required to isolate prior to surgery. New research shows that, against expectations, patients isolating before surgery (mainly to avoid COVID-19 and its complications) may actually be at up to 20% increased risk of developing postoperative lung complications compared with patients who do not isolate. In Finland, isolation prior to surgery is not currently recommended, but instructions vary between hospitals and units.
Joonas Kauppila

The study was delivered by the University of Birmingham-led GlobalSurg-COVIDSurg Collaborative: 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, including 14 hospitals from the Nordic countries. Overall, 28% of patients isolated before surgery. Postoperative pulmonary complications were recorded in 2% of patients of which 12% were associated with SARS-CoV-2 infection.

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% vs. 2.0%, respectively), pre-operative isolation was associated with a 20% 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 3 days, with isolation of 4 to 7 days associated with 25% increased risk of post-operative lung complications and isolation of 8 days or longer associated with a 31% 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.

Docent Joonas Kauppila from the University of Oulu and Oulu University Hospital, the national lead of the study in Finland, comments these unexpected findings: “Even though the isolation has been thought to have benefits, it may actually lead to reduced physical activity, worse nutritional habits and higher levels of anxiety and depression in our patients. Anesthesia and surgery are already associated with a risk of pulmonary complications, and after isolation these patients might start off even worse when coming to surgery.”

Kauppila adds: “Isolation of surgical patients may not be beneficial to themselves, at least not in all situations. Not isolating may however increase transmission between patients or to the healthcare staff. Unfortunately, we were unable to track any transmissions to other patients or personnel in this study”

“Our view is that preoperative testing, as shown in our previous study, might be more beneficial for reducing risk of Covid-19 related complications, including pulmonary complications. Testing may also reduce transmissions between patients. Preoperative isolation should be used with caution, for example in high-risk patients in areas with high infection rates. Prehabilitation, or preconditioning, prior to surgery in isolation might be one way to mitigate these risks. It has been shown to improve patient recovery after surgery for some cancers. However, further research is needed to evaluate the benefits of preconditioning in surgical patients in general. On the other hand, exercise in general would benefit many, regardless of COVID or surgery.”

The study was recently published in Anaesthesia

Research article: COVIDSurg Collaborative, GlobalSurg Collaborative. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study. Anaesthesia (2021).

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Last updated: 25.8.2021