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

COVIDSurg Collaborative, and GlobalSurg Collaborative, (2021) Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia, 76(6), pp. 748-758. (doi: 10.1111/anae.15458) (PMID:33690889) (PMCID:PMC8206995)

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.

• Item Type: Articles
• Additional Information: Simon Lammy is a member of the COVIDSurg and GlobalSurg Collaboration.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lammy, Dr Simon
• Authors: COVIDSurg Collaborative, , and GlobalSurg Collaborative,
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Anaesthesia
• Publisher: Wiley
• ISSN: 0003-2409
• ISSN (Online): 1365-2044
• Published Online: 09 March 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Anaesthesia 76(6): 748-758
• Publisher Policy: Reproduced under a Creative Commons License