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

Nepogodiev, Dmitri and Collaborative, COVIDSurg and Collaborative, GlobalSurg and Ab. Rahman, Norhafiza and Ab Rashid, Islah Munjih and Abd Aziz, Mohd Fahmi and Abdul Rahman, Mohd Norhisham Azmi and Amjad, Nasser Muhammad and Che Alhadi, Shahidah and Elagili, Faisal and Kamarulzaman, Mohd Nazli and Md Nor, Azmi and Othman, Ahmad Faidzal and Sainal, Mohd. Yusof and Sarif, Mat Salleh (2021) Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia, 76 (6). pp. 748-758. ISSN 0003-2409 E-ISSN 1365-2044

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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.

Item Type:	Article (Journal)
Additional Information:	89115/7054
Uncontrolled Keywords:	COVID‐19, delay, SARS‐CoV‐2, surgery, timing
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RD Surgery
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Surgery
Depositing User:	Dr Norhafiza Ab. Rahman
Date Deposited:	05 Apr 2021 14:58
Last Modified:	18 May 2021 21:33
URI:	http://irep.iium.edu.my/id/eprint/89115

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