COVIDSurg CollaborativeNIHR Global Health Research Unit on Global Surgery2026-10-012026-10-012026-03COVIDSurg Collaborative & NIHR Global Health Research Unit on Global Surgery 2026, '30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic : a pooled analysis of prospective international cohort studies', The Lancet Regional Health - Europe, vol. 62, 101566. https://doi.org/10.1016/j.lanepe.2025.1015662666-7762PubMedCentral: PMC12870846https://hdl.handle.net/10641/8442Publisher Copyright: © 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/Antecedentes: Los servicios quirúrgicos estaban mal preparados para la pandemia de COVID-19, lo que provocó una disrupción generalizada de la actividad electiva. Este estudio tuvo como objetivo identificar prioridades procesables para fortalecer la preparación ante pandemias de los sistemas quirúrgicos y hospitalarios. Métodos: Este estudio combinó datos de tres estudios de cohorte internacionales y prospectivos que incluyeron pacientes con un resultado positivo de SARS-CoV-2 en los siete días previos o dentro de los 30 días posteriores a la cirugía. Los pacientes se incluyeron en cuatro periodos pandémicos: Periodo 1 (enero–mayo de 2020), Periodo 2 (junio–julio de 2020), Periodo 3 (octubre de 2020) y Periodo 4 (diciembre de 2021–marzo de 2022). La medida de resultado primaria fue la mortalidad postoperatoria a 30 días. Se desarrollaron modelos de regresión logística jerárquica para explorar la asociación entre los periodos pandémicos (análisis primario) y la preparación a nivel hospitalario (análisis secundario) con la mortalidad postoperatoria a 30 días. La preparación hospitalaria se clasificó en terciles de baja, moderada y alta preparación según la puntuación del Surgical Preparedness Index (SPI). Resultados: Se incluyó un total de 31.751 pacientes de 1589 hospitales y 102 países. Del Periodo 1 al Periodo 4 se observó una disminución en la proporción de pacientes de ≥70 años y con grados ASA 3–5. La mortalidad postoperatoria a 30 días descendió desde el Periodo 1 (18,4% [1378/7502]), Periodo 2 (9,9% [219/2234], razón de posibilidades ajustada (aOR) 0,65, intervalo de confianza (IC) del 95% 0,53–0,78), Periodo 3 (10,5% [246/2427], aOR 0,60, IC 95% 0,50–0,71), hasta el Periodo 4 (5,8% [1132/19.588], aOR 0,33, IC 95% 0,30–0,37). Durante el Periodo 4, los pacientes vacunados frente a SARS-CoV-2 presentaron menor mortalidad que los no vacunados (4,9% [603/12.361] frente a 7,4% [529/7178], aOR 0,49, IC 95% 0,42–0,57). En comparación con los hospitales con baja preparación (11,2% [1019/9071]), los hospitales con preparación moderada (9,4% [857/9071], aOR 0,84, IC 95% 0,75–0,94) y alta (5,8% [530/9071], aOR 0,70, IC 95% 0,62–0,80) presentaron menor mortalidad. Interpretación: La mortalidad postoperatoria disminuyó a lo largo de la pandemia de COVID-19 y fue menor en los hospitales mejor preparados. Los hospitales son infraestructura nacional crítica, y fortalecer su preparación mediante el desarrollo de planes formales de pandemia, el establecimiento de protocolos de priorización de pacientes y procedimientos, y la reserva de camas quirúrgicas garantizaría una atención quirúrgica más segura durante futuras pandemias. Financiación: National Institute for Health and Care Research, Reino Unido. [Traducción automática al español; idioma original: inglés.]Background: 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. Funding: National Institute for Health and Care Research, United Kingdom.112595097enghttp://creativecommons.org/licenses/by-nc-nd/4.0/COVID-19Health system preparednessPandemic preparednessPostoperative mortalitySARS-CoV-2SurgeryInternal MedicineOncologyHealth PolicyPublic Health, Environmental and Occupational HealthSDG 3 - Good Health and Well-beingJournal ArticleYesjournal articleopen access10.1016/j.lanepe.2025.101566https://www.scopus.com/pages/publications/105041170435https://www.scopus.com/pages/publications/105041170435#tab=citedBy