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30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studies

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dc.contributor.authorGarcía Pérez, Daniel
dc.contributor.authorNepogodiev, Dmitri
dc.contributor.authorKamarajah, Sivesh K.
dc.contributor.authorBhangu, Aneel
dc.contributor.authorAacharya, Radhika
dc.contributor.authorAhmed, Waheed-Ul-Rahman
dc.contributor.authorElAmeer, Ehab
dc.contributor.authorBlanco-Colino, Ruth
dc.contributor.authorElhadi, Muhammed
dc.contributor.authorGhosh, Dhruva
dc.contributor.authorGlasbey, James C.
dc.contributor.authorIsik, Arda
dc.contributor.authorJolly, Kate
dc.contributor.authorKaafarani, Haytham
dc.contributor.authorKadir, Bryar
dc.contributor.authorLederhuber, Hans
dc.contributor.authorLeventoğlu, Sezai
dc.contributor.authorOmar, Omar M.
dc.contributor.authorPata, Francesco
dc.contributor.authorPicciochi, Maria
dc.contributor.authorPockney, Peter
dc.contributor.authorNIHR Global Health Research Unit on Global Surgery
dc.contributor.authorCOVIDSurg Collaborative
dc.contributor.departmentFarmacología
dc.contributor.otherFacultad de Farmacia
dc.date.accessioned2026-02-27T08:30:50Z
dc.date.available2026-02-27T08:30:50Z
dc.date.copyright© 2025 The Authors
dc.date.issued2026-01-29
dc.description.abstractBackground: Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems. Methods: This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score. Findings: A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality. Interpretation: Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics.
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dc.identifier.citationNIHR Global Health Research Unit on Global Surgery. 30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studies. Lancet Reg Health Eur. 2026 Jan 29;62:101566. doi: 10.1016/j.lanepe.2025.101566
dc.identifier.doihttps://doi.org/10.1016/j.lanepe.2025.101566
dc.identifier.eissn2589-7500
dc.identifier.urihttp://hdl.handle.net/10201/215361
dc.languageeng
dc.publisherElsevier
dc.relationNational Institute for Health and Care Research, United Kingdom
dc.relation.publisherversionhttps://www.sciencedirect.com/science/article/pii/S2666776225003588
dc.rightsAttribution 4.0 International*
dc.rights.accessRightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectPandemic preparedness
dc.subjectHealth system preparedness
dc.subjectCOVID-19
dc.subjectSARS-CoV-2
dc.subjectSurgery
dc.subjectPostoperative mortality
dc.subject.odsNo relacionado con ningún objetivo de desarrollo sostenible
dc.title30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studies
dc.typeinfo:eu-repo/semantics/article
dc.type.versioninfo:eu-repo/semantics/publishedVersión
dspace.entity.typePublicationes
relation.isAuthorOfPublication2f2500a1-1b27-4420-820c-db8c16e79afd
relation.isAuthorOfPublication.latestForDiscovery2f2500a1-1b27-4420-820c-db8c16e79afd
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