When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA

Abstract

Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially “Long Covid”) in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.

Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

“…Global or local lockdown policies and recommendations regarding postponement of elective therapies during the last two pandemic years aim at providing necessary health care capacities especially during wave-like outbreaks of different variants of SARS-CoV-2. Therefore, the discussion behind postponements of elective surgical therapies is primarily to hold up bed, intensive care as well as operating room capacities available during the pandemic and secondarily to preserve patients and medical staff from nosocomial infection with SARS-CoV-2 [1][2][3][4]. However, postponement of elective surgical therapies might not be detrimental in the short-term follow-up upon diagnosis, but delayed treatments might have some harmful effects beyond that short range in the longer-term outcome [2].…”

“…Since the rapid spread of the SARS-CoV-2 around the world in late 2019, a high amount of research had been published regarding the pandemic, the characteristics of the virus and treatment modalities of COVID-19, which are urgently needed [4]. However, the literature reveals some evidence about dramatic negative effects of the pandemic on various medical fields and health care services, e.g., in oncology, cardiovascular diseases, etc., as well as on the outcome of respective patients [5,[11][12][13][14].…”

Outcomes of elective cancer surgery in COVID‐19 survivors: An observational study

“…15 A recent review identified 10 studies that looked at surgical outcomes in patients with perioperative SARS CoV2 infection. 16 However, the studies were heterogeneous (different countries, retrospective vs.…”

“…prospective, inclusion of patients with pre and postoperative infection, variable techniques of testing for COVID-19, small sample sizes, elective and emergency procedures and surgeries of varying complexity) making the interpretation of their results difficult. 16 Surgery for cancer (solid tumors) is a key treatment modality, is often complex and may be associated with significant perioperative morbidity. Oncological surgery is considered semi-urgent since any delays could result in progression of cancer, potentially rendering the patient inoperable.…”

“…Baiocchi studied 49 patients who underwent elective surgery at a median of 25 days after their COVID‐19 diagnosis, with no increase in complications compared to matched controls 15 . A recent review identified 10 studies that looked at surgical outcomes in patients with perioperative SARS CoV2 infection 16 . However, the studies were heterogeneous (different countries, retrospective vs. prospective, inclusion of patients with pre and postoperative infection, variable techniques of testing for COVID‐19, small sample sizes, elective and emergency procedures and surgeries of varying complexity) making the interpretation of their results difficult 16 …”