COVID-19 Management

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

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

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

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)

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

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