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Timing of Surgery Following SARS‐CoV‐2 Infection
Quick Takes
- Elective surgery should be delayed for ≥7 weeks following SARS‐CoV‐2 infection to reduce the risk of postoperative mortality and pulmonary complications.
- In addition, patients who are still symptomatic ≥7 weeks after SARS‐CoV‐2 infection may benefit from a further delay until their symptoms resolve.
Study Questions:
What is the optimal duration of planned delay before surgery in patients who have had severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection?
Methods:
The investigators conducted an international, multicenter, prospective cohort study that included patients undergoing elective or emergency surgery during October 2020. Surgical patients with preoperative 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.
Results:
Among 140,231 patients (116 countries), 3,127 patients (2.2%) had a preoperative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95% confidence interval [CI], 1.4–1.5). In patients with a preoperative 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 [OR], 4.1% [95% CI, 3.3–4.8]; OR, 3.9% [95% CI, 2.6–5.1]; and OR, 3.6% [95% CI, 2.0–5.2], respectively). Surgery performed ≥7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (OR, 1.5%; 95% CI, 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).
Conclusions:
The authors concluded that where possible, surgery should be delayed for ≥7 weeks following SARS‐CoV‐2 infection.
Perspective:
This study reports that patients operated within 6 weeks of SARS‐CoV‐2 diagnosis were at an increased risk of 30‐day postoperative mortality and 30‐day postoperative pulmonary complications. These risks decreased to baseline in patients who underwent surgery ≥7 weeks after SARS‐CoV‐2 diagnosis. These data suggest that surgery should be delayed for ≥7 weeks following SARS‐CoV‐2 infection to reduce the risk of postoperative mortality and pulmonary complications whenever possible. In addition, patients who are still symptomatic ≥7 weeks after SARS‐CoV‐2 infection and undergo surgery also have an increased mortality rate. Such patients may benefit from a further delay until their symptoms resolve.
Clinical Topics: COVID-19 Hub, Prevention, Valvular Heart Disease
Keywords: Anesthesia, Coronavirus, COVID-19, Emergency Medical Services, Outcome Assessment, Health Care, Preoperative Period, Primary Prevention, Pulmonary Valve Insufficiency, Risk, SARS-CoV-2, Elective Surgical Procedures, Minor Surgical Procedures
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