By Chioma Obinna

A new global study has found that patients isolating before surgery – mainly to avoid COVID-19 and its complications are at 20 percent increased risk of developing postoperative lung complications compared with patients who do not isolate.

The research published in Anaesthesia (a journal of the Association of Anaesthetists) noted that the finding goes completely against the current guidance in common use which mandates isolation before surgery.

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, and,overall, 26,948 (28 percent) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0 percent) patients of which 227 (11.7 percent) were associated with SARS-CoV-2 infection.

The study found that 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.

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The researchers noted that although the overall rates of postoperative pulmonary complications were similar in patients who isolated and those that did not  pre-operative isolation was associated with a 20 percent increased risk of postoperative pulmonary complications after adjustment for age, comorbidities, and type of surgery performed.

The study noted that 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 percent increased risk of post-operative lung complications and isolation of 8 days or longer associated with a 31 percent increased risk.

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

Speaking on the unexpected findings, one of the study’s lead authors, Senior Lecturer and Surgeon Dr Aneel Bhangu, from the University of Birmingham-led National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, 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, a Research Fellow at the University of Birmingham’s NIHR Global Health Research Unit on Global Surgery said: “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.”

According to the co-author and national lead in Nigeria Prof Adesoji Ademuyiwa of the College of Medicine, University of Lagos, the result of this study will help institutions in LMICs to formulate appropriate guidelines in critical times like this.

The authors however warned that the study does not take into account the risk of transmission of SARS-CoV-2 from patients to other patients and staff in hospital.

They said: “The benefits of preoperative isolation are not only for the individual patient but also to other patients and staff in hospitals who are at risk from asymptomatic carriers of SARS-CoV-2.”

The authors say: “Healthcare providers may wish to take these findings into consideration when reviewing local and national guidance.

“Relaxation of pre-operative isolation policies appears to be safe for individual patients, especially in the presence of preoperative testing, which this and previous studies showed to be beneficial.

“Selected isolation practices may remain in place in certain conditions (such as high-risk patients and periods of high community prevalence).”

“Further research is needed to explore the most effective method for maintaining patient fitness and conditioning in patients that are isolating, which may include home or remote prehabilitation using telehealth methods.”

Vanguard News Nigeria