Timing of surgery following SARS-CoV-2 infection: An international prospective cohort stud
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Date
2021-02-26
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Journal ISSN
Volume Title
Publisher
Association of Anaesthestetics Great Britain and Ireland.
Abstract
Summary
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-2diagnosiswasassociatedwithasimilarmortalityrisk tobaseline(oddsratio(95%CI)1.5(0.9–2.1)). After a
≥ 7 weekdelayinundertakingsurgery following SARS-CoV-2 infection, patients with ongoing symptoms hada
highermortalitythanpatientswhosesymptomshadresolvedorwhohadbeenasymptomatic(6.0%(95%CI3.2
8.7) vs. 2.4%(95%CI1.4–3.4)vs.1.3%(95%CI0.6–2.0),respectively).Wherepossible,surgeryshouldbedelayed
for at least 7 weeksfollowingSARS-CoV-2infection.Patientswithongoingsymptoms≥ 7 weeksfromdiagnosis
maybenefitfromfurtherdelay
Description
article
Keywords
COVID-19, delay, SARS-CoV-2, surgery, timing