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Avoiding thoracotomy and using pathways that minimize exposure to SARS-CoV-2 may reduce the risk of COVID-19 among patients undergoing surgery for non-small cell lung cancer (NSCLC), according to research presented at the IASLC 2021 World Conference on Lung Cancer (WCLC).
The research involves data from CovidSurg, a group of studies representing 2006 hospitals in 120 countries. The studies include data on 190,261 patients undergoing surgery during the COVID-19 pandemic.
For the WCLC presentation, researchers reported on CovidSurg data from patients undergoing surgery for NSCLC. The researchers analyzed data dating back to the initial 3-month period after the COVID-19 pandemic began. Outcomes were compared between patients who developed perioperative COVID-19 and those who did not.
Between March and July 2020, 1486 patients underwent surgery for NSCLC in 83 of the hospitals contributing data to CovidSurg. In all, 74 patients developed perioperative COVID-19, and 1412 did not.
Perioperative COVID-19 was associated with a 30-day mortality rate of 26%. Patients who developed COVID-19 were also more likely to undergo re-operation and be admitted to critical care.
A multivariate analysis suggested the following factors were predictive of perioperative COVID-19:
- Male sex (odds ratio [OR], 2.06; P =.027)
- Pre-existing respiratory disease (OR, 2.82; P =.001)
- Proven prior COVID-19 (OR, 27.2; P <.001)
- Probable prior COVID-19 (OR, 15.5; P <.001)
- Open surgery (OR, 2.32; P =.011)
- Lack of a COVID-19-free pathway (OR, 3.07; P =.025).
A COVID-free pathway was defined as complete segregation of the operating theater, critical care, and inpatient ward areas.
The researchers also found that perioperative COVID-19 was “the strongest independent predictor” of postoperative pulmonary complications, which was a composite endpoint encompassing pneumonia, acute respiratory distress syndrome, respiratory failure, and the need for respiratory support (OR, 7.4; P <.001).
Perioperative COVID-19 was predictive of 30-day mortality as well (OR, 11.6; P <.001).
Patel AJ, Caruana EJ, Layton G, et al. Global impact of COVID-19 on NSCLC surgery: Initial analysis of the CovidSurg-Cancer study. Presented at: IASLC 2021 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer; September 8-14, 2021. Abstract P31.04.