Patients who isolate before surgery 20% more likely to develop post-operation lung problems, study finds

Study’s conclusions were unexpected and go against current medical guidance, writes Lamiat Sabin

Self-isolation before surgery could lead to worse outcomes for lung health, researchers found (iStock)

Hospital patients who self-isolate before undergoing surgery are more likely to develop post-operation lung problems, new findings from a global study suggest.

Patients who self-isolate before surgery, mainly to avoid contracting Covid-19, have been shown to have a 20 per cent increased risk of developing lung complications compared with those that do not self-isolate.

A patient could see the condition of their lungs decline after surgery due to lack of exercise, worse diet, and higher levels of anxiety and depression during self-isolation, the researchers said.

The findings of the study, involving data collected by more than 15,000 surgeons, are in contrast with current medical guidance that mandates isolation before surgical procedures.

In the UK, the NHS states that patients undergoing elective surgery and the people they live with need to self-isolate, and “may” need to be tested for Covid, before being admitted to hospital.

But the researchers said that testing for Covid before surgery combined with “relaxed” self-isolation policies could see improved rates of post-surgery lung health.

The researchers stressed that this could only be the case for patients at low-risk of contracting Covid living in countries with low rates of transmission of the virus.

A total of 96,454 patients from more than 1,600 hospitals across 114 countries were included in their new analysis.

Some 28 per cent of the patients, a total of 26,948 people, went into isolation before surgery. They were found to be older, have more existing respiratory issues, and were more commonly from areas with high rates of Covid infection in more wealthy countries.

Although the overall rates of post-operative lung complications were similar in patients who isolated and those that did not (2.1 per cent and 2 per cent respectively), isolation was linked to a 20 per cent increased risk of pulmonary complications after adjusting for age, comorbidities, and type of surgery performed.

Post-operative lung complications were recorded in 1,947 patients, and 227 of this number (11.7 per cent) were linked to Covid infection.

The rate of post-operative pulmonary complications also increased with periods of isolation longer than three days.

Isolation between four and seven days is associated with 25 per cent increased risk of such complications, and isolation of eight days or longer is associated with a 31 per cent increased risk.

The researchers concluded that isolation does not seem to protect surgical patients from post-operative pulmonary complications or death.

Dr Aneel Bhangu, senior lecturer and surgeon from the University of Birmingham-led National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, said the study’s outcomes suggest that isolation “conversely led to patient deconditioning and functional decline, adversely influencing their outcomes.”

Dr Joana Simoes, co-lead author and NIHR research fellow, said: “Our evidence suggests that removing pre-operative isolation strategies is unlikely to lead to worse post-operative outcomes for patients, but institutions should monitor their post-operative pulmonary complication rates as strategies evolve.”

The authors do however warn that the study does not take into account the risk of transmission of Covid-19 from patients to other patients and staff in hospital.

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

The authors have said that healthcare providers “may wish to take these findings into consideration when reviewing local and national guidance”.

The research has been published in the journal Anaesthesia.