Mortality Risk Up Many Fold If Op Done Within 6 Weeks: Study

DurgeshNandan.Jha@timesgroup.com

New Delhi:14.03.2021 

It’s better to delay surgery, except for emergencies, if you have been diagnosed with Covid-19 recently. A new study shows that people who undergo surgery within six weeks of being Covid-positive are more than two-and-a-half times more likely to pass away compared with those who don’t have the infection.

The risk goes up further if the time of surgery is closer to the diagnosis of Covid-19, the study published in medical journal Anaesthesia says. The analysis was based on over 1.4 lakh surgeries conducted in 1,674 hospitals in 116 countries. This included 56 hospitals from India, including All India Institute of Medical Sciences.

Dr Shilpa Sharma, who led the study from AIIMS, told TOI, “While it is a known fact that SARS-CoV-2 infection during surgery increases the mortality risk, this is the first time a study has given evidence about the least amount of time delay in surgeries that would optimise final outcomes.”

“In all, 31 doctors from AIIMS participated in the study. We analysed deaths and pulmonary complications recorded within 30 days in patients who underwent surgery in departments such as paediatric, orthopaedics, cardiothoracic and general surgery and neurosurgery. It showed that patients with current and past history of Covid-19 were at higher risk of postsurgery complications and even death,” added Sharma.

The doctor said that this could be because Covid-19 causes systemic inflammation. “The infection affects the lungs. Administering anaesthesia isn’t easy. Also, most such patients have low immunity and the risk of postoperative infection is high. The decision to delay surgery needs to be balanced by the disease risk to the patient,” she added.

At AIIMS, RT-PCR and CBNAAT tests are carried out routinely to screen all surgical patients. Surgery is delayed for those who test positive, wherever possible, till the patients recover.

The study showed that time of surgery from the diagnosis of Covid-19 was inversely proportional to the risk of death and even pulmonary complications.

Of the 1,40,231 patients who underwent surgery at different hospitals during the study period (October 2020), 3,127 were diagnosed with current or recent history of Covid-19.

The 30-day post-operative mortality in patients who underwent surgery in 0-2 weeks of diagnosis of Covid-19 was 9.1%, 6.9% within 3-4 weeks of the infection, 5.5% within 5-6 weeks of contracting Covid-19, and 2% in those who were operated upon after seven weeks of being infected with the virus.

Lockdown again not the solution: Experts

Nisha Nambiar & Tushar Pawar TNN

District administrations in parts of Maharashtra — faced with a fresh surge in cases — recently enforced new curbs and warned citizens of a complete lockdown. But health experts said a lockdown — often described as the ‘nuclear’ option in disease containment — is not the solution to stopping Covid-19.

State surveillance officer Pradeep Awate said the lockdown was the “pause button” governments hit at the start of the pandemic to shore up health infrastructure. “Now, with that infrastructure ready, a lockdown is not the answer. After a year of the pandemic, focus is on stopping the spread in clusters.”

In fact, many public health experts have said the recent surge in some parts of the state was caused by large crowds that had gathered for the gram panchayat elections and weddings. The experts added that widespread curbs, when rules are being ignored, are of no use at all.

Scientists have said that people dropping masks and distancing rules remain the biggest hurdle to containment. Evidence is growing that facial covers can stop the spread of droplets from the mouth. An experiment using high-speed video found that hundreds of droplets ranging from 20 to 500 micrometers were generated when saying a simple phrase, but that nearly all these droplets were blocked when the mouth was covered by a damp washcloth.

Real-world research too has found that masks come with immense benefits.