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

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.

Re: A systematic review and meta-analysis: The effect of active cancer treatment on severity of COVID-19

“…Given this reason, guidelines propose to postpone elective surgery in patients with less aggressive cancers. This is consistent with a recent study showing that mortality is increased in surgical patients at a closer time interval between surgery and COVID-19 diagnosis [ 5 ]. The negative association between cancer surgery and risk of either severe events or death from COVID-19 shown by Yekedüz et al.…”

Impact of COVID-19 on the outcomes of gastrointestinal surgery

“…The authors also reported that the risk of pulmonary complications and mortality was lowest when the surgery was performed at least 4 weeks after the positive swab test in those with SARS-CoV-2 infection [33]. A subsequent large-scale study by the COVIDSurg collaborative involving 140,231 patients from 116 countries found that surgeries performed more than 7 weeks after the diagnosis of SARS-CoV-2 infection was associated with similar mortality risk as that of those without history of SARS-CoV-2 infection [34]. They reported that the 30-day mortality in patients without SARS-CoV-2 infection was 1.5% while in those with SARS-CoV-2 infection was 4.1%, 3.9%, 3.6% and 1.5% in patients having surgery within 0-2 weeks, 3-4 weeks, 5-6 weeks and ≥ 7 weeks, respectively [34].…”

Estrategia de vacunación en México y diversidad de vacunas.

“…En primer lugar, miembros de nuestro equipo han participado en estudios de cohorte internacionales donde se ha determinado que los pacientes que son sometidos a cirugías de cualquier especialidad después de haber padecido COVID-19 tienen un incremento en la mortalidad del 23.8%, mientras que las complicaciones pulmonares ocurren en el 38% de ellos 11 . Siguiendo la misma línea de pensamiento, estudiamos a continuación cuánto tiempo debía pasar después de padecer COVID-19 para que la cirugía no implicase un riesgo adicional de mortalidad, encontrando que el tiempo óptimo para realizar las intervenciones es de siete semanas 12 . En muchas ocasiones, sin embargo, no puede pasar tanto tiempo para que el paciente se someta a cirugía, por ejemplo en cesáreas, remoción de tumores, ciertas colecistectomías, etc.…”