30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studies
Authors: NIHR Global Health Research Unit on Global Surgery, and COVIDSurg Collaborative
Site: Barwon Health, VIC
During the pandemic, Dr Lambers joined an international research team called CovidSurg, contributing cases for worldwide comparison and analysis examining topics such as isolation, vaccine effectiveness and safe timing of operations. This study focused on how early in the COVID-19 pandemic, patients who developed COVID-19 around the time of surgery faced a very high risk of death. This international study looked at how that risk changed over time and whether better-prepared hospitals achieved better outcomes.
The researchers, including Dr Lambers, combined 31,751 patients from 1,589 hospitals in 102 countries who tested positive for COVID-19 shortly before or after surgery. The improvement over time was substantial. In the first wave of the pandemic, 18.4% of patients died within 30 days of surgery. By late 2021 to early 2022, this had fallen to 5.8%. Vaccination also appeared protective, with mortality of 4.9% in vaccinated patients compared with 7.4% in unvaccinated patients.
Hospital preparedness also mattered. Mortality was 5.8% in highly prepared hospitals compared with 11.2% in poorly prepared hospitals. Important features included formal pandemic plans, systems for prioritising patients and procedures, appropriate preoperative assessment, and protected surgical theatres and beds.
The study suggests that the improved outcomes were due to several factors, including better patient selection, vaccination, increasing immunity and changes in the virus itself. It also highlights that hospitals with strong systems and clear contingency plans were better able to provide safe surgical care during a major health crisis. The main message is that preparation matters. Maintaining protected surgical capacity and clear emergency plans may help hospitals continue essential surgery more safely during future pandemics or other major disruptions.
