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May 30: Patients undergoing surgery after contracting the novel coronavirus are at an increased risk of postoperative death, according to a new study published in The Lancet journal which may lead to better treatment guidelines for COVID-19.

In the study, the scientists, including those from the University of Birmingham in the UK, examined data from 1,128 patients from 235 hospitals from a total of 24 countries.

Among COVID-19 patients who underwent surgery, they said the death rates approach those of the sickest patients admitted to intensive care after contracting the virus.

The scientists noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection.

According to the study, the 30-day mortality among these patients was nearly 24 per cent.

The researchers noted that mortality was disproportionately high across all subgroups, including those who underwent elective surgery (18.9 per cent), and emergency surgery (25.6 per cent).

Those who underwent minor surgery, such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or for colon cancer also had higher mortality rates (26.9 per cent), the study said.

According to the study, the mortality rates were higher in men versus women, and in patients aged 70 years or over versus those aged under 70 years.

The scientists said in addition to age and sex, risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

"We would normally expect mortality for patients having minor or elective surgery to be under 1 per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%)," said study co-author Aneel Bhangu from the University of Birmingham.

Bhangu said these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

Citing an example from the 2019 UK National Emergency Laparotomy Audit report, he said the 30-day mortality was 16.9 per cent in the highest-risk patients.

Based on an earlier study across 58 countries, Bhangu said the 30-day mortality was 14.9 per cent in patients undergoing high-risk emergency surgery.

"We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice," he said.

"For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed," Bhangu added.

The study also noted that patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital.

It noted that the patients may also be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

The scientists found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

Nearly 82 per cent of the patients who died had experienced pulmonary complications, the researchers said.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19," said co-author Dmitri Nepogodiev from the University of Birmingham.

"Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital," Nepogodiev said.

According to the researchers, there's now an urgent need for investment by governments and health providers in to measures which ensure that as surgery restarts patient safety is prioritised.

They said this includes the provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres.

New Delhi, Jun 18: Vodafone Idea on Thursday told the Supreme Court that it has incurred Rs 1 lakh crore losses as it insisted it is not in a position to furnish bank guarantees.

A bench comprising Justices Arun Mishra, S. Abdul Nazeer, and M.R. Shah, taking up the adjusted gross revenue (AGR) matter through video conferencing, directed the telecom companies to submit their financial documents and books for the last 10 years.

Asking Vodafone if it was a foreign company, the bench said that how can the company say it would not furnish any bank guarantee.

"What if you fly away overnight in future without paying anything?" it asked.

Senior advocate Mukul Rohatgi, representing Vodafone Idea, denied his client is a completely foreign firm and cited before the bench its tie-ups and investments.

Vodafone owes over Rs 58,000 crore as AGR dues and so far, has paid close to Rs 7,000 crore.

Rohatgi contended before the court that the telecom company is in a tough situation, and cannot furnish any fresh bank guarantee, as profits have eluded the company in past many quarters. He submitted before the bench that Rs 15,000 crore bank guarantees are lying with the government, and his client's losses are over Rs 1 lakh crore.

"I cannot offer any more surety," he informed the bench.

Justice Mishra noted that this is public money and these dues should be recovered. "Do not tell us that you will pay if you were to make profits... the money must come," he noted.

Justice Shah observed that the telecom industry is the only industry which earned during the Covid-19 pandemic. "After all, this money will be used for public welfare", he said.

Rohatgi argued that his client would have to fold up if orders were issued to clear dues tomorrow. "11,000 employees will have to go without notice, as we cannot pay them," he added.

Senior advocate Abhishek Manu Singhvi, appearing for Bharti Airtel, contended before the court that out of Rs 21,000 crore AGR dues, the company has already deposited a sum of Rs 18,000 crore.

He argued that his client has given a bank guarantee, in excess of demand, to DoT, and supported the proposal for phased repayment of remaining AGR dues. He insisted that the company needs to sit down with the government and calculate the dues. Airtel owes Rs 25,976 crore after paying Rs 18,000 crore, as per the government.

Senior advocate Arvind Datar, representing Tata Telecom, informed the bench that his client has paid Rs 6,504 crore in AGR dues so far, and furnishing a bank guarantee may adversely impact investments in the sector.

The total AGR dues are close to Rs 1.5 lakh crore.

The top court will now take up the matter in the third week of July.