Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study
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Date
2021-03-09
Authors
COVIDSurg Collaborative
GlobalSurg Collaborative
Journal Title
Journal ISSN
Volume Title
Publisher
Anaesthesia
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.
Description
Scholarly articles
Keywords
COVID-19; SARS-CoV-2; delay; surgery; timing , COVID 19 , Surgery , Timing , SARS-CoV-2 infection
Citation
COVIDSurg Collaborative, GlobalSurg Collaborative: Adesoji Ademuyiwa, Bosede Afolabi, Peter Ajayi, Opeyemi Akinajo, Felix Alakaloko, Oluwole Atoyebi, Orimisan Belie, Chris Bode, Ihediwa Chibuike George, Olumide Elebute, Francis Ezenwankwo, Adedeji Fatuga, Oluwaseun Ladipo-Ajayi, Ayomide Makanjuola, Christian Makwe, Bolaji Mofikoya, Ephraim Ohazurike, Rufus Wale Ojewola, Kehinde Okunade, Adeyemi Okunowo, Thomas Olagboyega Olajide, Oluwafemi Oni, Justina Seyi-Olajide, Kehinde Tijani, Andrew Ugburo, Aloy Okechukwu Ugwu (collaborators from Lagos University Teaching Hospital, Idi Araba). Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study. Anaesthesia. 2021;76: 748–58. https://doi.org/10.1111/anae.15458