Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

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Date

2021-06

Journal Title

Journal ISSN

Volume Title

Publisher

Wiley-Blackwell Publishing Ltd.

Abstract

Description

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5%(95% CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95% CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95% CI) 1.5 (0.9–2.1)). After a≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0%(95% CI 3.2–8.7) vs. 2.4%(95% CI 1.4–3.4) vs. 1.3%(95% CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 …

Keywords

COVID-19, delay, surgery, timing, SARS-CoV-2

Citation

COVIDSurg Collaborative. (2021). Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia, 76(6), 748-758.