Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study
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Published version
Author(s)
COVIDSurg Collaborative
GlobalSurg Collaborative
Type
Journal Article
Abstract
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 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
Date Issued
2021-06-01
Date Acceptance
2021-02-26
Citation
Anaesthesia, 2021, 76 (6), pp.748-758
ISSN
0003-2409
Publisher
Wiley
Start Page
748
End Page
758
Journal / Book Title
Anaesthesia
Volume
76
Issue
6
Copyright Statement
© 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Identifier
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15458
Subjects
Science & Technology
Life Sciences & Biomedicine
Anesthesiology
COVID-19
delay
SARS-CoV-2
surgery
timing
PULMONARY COMPLICATIONS
MULTICENTER
COVID-19
SARS-CoV-2
delay
surgery
timing
COVIDSurg Collaborative
GlobalSurg Collaborative
Humans
Surgical Procedures, Operative
Cohort Studies
Prospective Studies
Time
Internationality
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Child
Child, Preschool
Infant
Female
Male
Practice Guidelines as Topic
Young Adult
COVID-19
SARS-CoV-2
Anesthesiology
1103 Clinical Sciences
1109 Neurosciences
Publication Status
Published
Date Publish Online
2021-03-09