ObjectivesTo confirm the incidence of perioperative SARS-CoV-2 infection and associated mortality after surgery. Design and settingAnalysis of routine electronic health record data from National Health Service (NHS) hospitals in England. MethodsWe extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between 1st January 2020 and 31st October 2020. The exposure was SARS-CoV-2 infection defined by ICD-10 codes. The primary outcome measure was 90-day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson co-morbidity index, index of multiple deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals. ResultsWe identified 1,972,153 patients undergoing surgery of whom 11,940 (0.6%) had SARS-CoV-2. In total, 19,100 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 2,618/11,940 [21.9%] vs No SARS-CoV-2: 16,482/1,960,213 [0.8%]; OR: 5.8 [5.5 - 6.1]; p<0.001). Amongst patients undergoing elective surgery 1,030/1,374,985 (0.1%) had SARS-CoV-2 of whom 83/1,030 (8.1%) died, compared with 1,092/1,373,955 (0.1%) patients without SARS-CoV-2 (OR: 29.0 [22.5 -37.3]; p<0.001). Amongst patients undergoing emergency surgery 9,742/437,891 (2.2%) patients had SARS-CoV-2, of whom 2,466/9,742 (25.3%) died compared with 14,817/428,149 (3.5%) patients without SARS-CoV-2 (OR: 5.7 [5.4 - 6.0]; p<0.001). ConclusionsThe low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed. Summary boxesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIHigh mortality rates have been reported amongst surgical patients who develop COVID-19 but we dont know how this compares to the concurrent surgical population unaffected by COVID-19. C_LIO_LIStrict infection prevention and control procedures have substantially reduced the capacity of surgical treatment pathways in many hospitals. C_LIO_LIThe very large backlog in delayed and cancelled surgical procedures is a growing public health concern. C_LI What this study addsO_LIFewer than 1 in 100 surgical patients are affected by COVID-19 in the English National Health Service. C_LIO_LIElective surgical patients who do develop COVID-19 are 30 times more likely to die while in hospital. C_LIO_LIInfection prevention and control procedures in NHS surgical pathways are highly effective but cannot be safely relaxed. C_LI
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