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COVID-19 Management

How Long Should Surgery Be Delayed Following SARS-CoV-2 Infection?

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BACKGROUND AND PURPOSE:

  • Previous SARS-CoV-2 infection is a risk factor for postoperative mortality
  • The COVIDSurg Collaborative (Anaesthesia, 2021) determined the optimal duration of planned surgery delay following SARS-CoV-2 infection

METHODS:

  • International, multicenter, prospective cohort study
  • Participants
    • Patients undergoing elective or emergency surgery during October 2020
  • Exposures
    • Preoperative SARS-CoV-2 infection
    • No history of SARS-CoV-2 infection
  • Study design
    • Logistic regression models were used to calculate adjusted 30‐day mortality rates
    • Stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery
  • Primary outcome
    • 30‐day postoperative mortality

RESULTS:

  • 140,231 surgical patients (116 countries)
    • Preoperative SARS-CoV-2 infection: 2.2%
  • Adjusted 30-day mortality in patients without SARS‐CoV‐2 infection
    • Baseline: 1.5% (95% CI, 1.4 to 1.5)
  • In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased compared to baseline in patients having surgery within
    • 0 to 2 weeks of diagnosis: Odds ratio (OR) 4.1 (95% CI, 3.3 to 4.8)
    • 3 to 4 weeks: OR 3.9 (95% CI, 2.6 to 5.1)
    • 5 to 6 weeks: OR 3.6 (95% CI, 2.0 to 5.2)
  • 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 to 2.1)
  • Even after ≥7 week delay following infection, patients with ongoing symptoms had a higher mortality vs those with symptom resolution or asymptomatic
    • Ongoing symptoms: 6.0% (95% CI, 3.2 to 8.7)
    • Resolved symptoms: 2.4% (95% CI, 1.4 to 3.4)
    • Asymptomatic: 1.3% (95% CI, 0.6 to 2.0)

CONCLUSION:

  • For surgery patients with a previous SARS-CoV-2 infection, postoperative mortality was increased if procedure performed within 7 weeks of diagnosis
  • Consider, if possible, delaying surgery till after 7 weeks following infection and perhaps later for symptomatic patients with COVID-19  

Learn More – Primary Sources:

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

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Related ObG Topics:

NIH COVID-19 Treatment Guidelines
COVID-19 Guidance: Key Highlights for Healthcare Professionals

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OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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