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

TY - JOUR

T1 - Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

AU - COVIDSurg Collaborative

AU - GlobalSurg Collaborative

AU - Betz, Christian Stephan

AU - Bewarder, Julian

AU - Bier, Johannes

AU - Böttcher, Arne

AU - Burg, Simon

AU - Busch, Chia-Jung

AU - Bußmann, Lara

AU - Gosau, Martin

AU - Heuer, Annika

AU - Izbicki, Jakob

AU - Klatte, Till Orla

AU - König, Daniela

AU - Köpke, Leon-Gordian

AU - Nitschke, Christine

AU - Praetorius, Mark Joachim

AU - Priemel, Matthias

AU - Stadlhofer, Rupert

AU - Stangenberg, Martin

AU - Uzunoglu, Faik Güntac

AU - Wittig, Lukas

AU - Zech, Henrike Barbara

AU - Zeller, Nina

N1 - © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

PY - 2021/6

Y1 - 2021/6

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - COVID-19

KW - Child

KW - Child, Preschool

KW - Cohort Studies

KW - Female

KW - Humans

KW - Infant

KW - Internationality

KW - Male

KW - Middle Aged

KW - Practice Guidelines as Topic

KW - Prospective Studies

KW - SARS-CoV-2

KW - Surgical Procedures, Operative/statistics & numerical data

KW - Time

KW - Young Adult

UR - https://doi.org/10.1111/anae.15458

U2 - 10.1111/anae.15458

DO - 10.1111/anae.15458

M3 - SCORING: Journal article

C2 - 33690889

VL - 76

SP - 748

EP - 758

JO - ANAESTHESIA

JF - ANAESTHESIA

SN - 0003-2409

IS - 6

ER -