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

ΤίτλοςTiming of surgery following SARS-CoV-2 infection: an international prospective cohort study.
Publication TypeJournal Article
Year of Publication2021
Corporate AuthorsCOVIDSurg Collaborative, & GlobalSurg Collaborative
JournalAnaesthesia
Volume76
Issue6
Pagination748-758
Date Published2021 06
ISSN1365-2044
Λέξεις κλειδιάAdolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Cohort Studies, COVID-19, Female, Humans, Infant, Internationality, Male, Middle Aged, Practice Guidelines as Topic, Prospective Studies, SARS-CoV-2, Surgical Procedures, Operative, Time, Young Adult
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.

DOI10.1111/anae.15458
Alternate JournalAnaesthesia
PubMed ID33690889
PubMed Central IDPMC8206995
Grant List / / Urology Foundation /
/ / Vascular Society for Great Britain and Ireland /
/ / NIHR Academy /
211122/Z/18/Z / WT_ / Wellcome Trust / United Kingdom
/ / Bowel Disease Research Foundation /
/ / Association of Coloproctology of Great Britain and Ireland /
CH/17/1/32804 / BHF_ / British Heart Foundation / United Kingdom
/ / British Association of Surgical Oncology /
/ / Sarcoma UK /
/ / Bowel and Cancer Research /
/ / Association of Upper Gastrointestinal Surgeons /
/ YCR_ / Yorkshire Cancer Research / United Kingdom
DRF-2018-11-ST2-028 / DH_ / Department of Health / United Kingdom
T32 DK060442 / DK / NIDDK NIH HHS / United States
/ / Medtronic /
/ / British Gynaecological Cancer Society /
K12 CA226330 / CA / NCI NIH HHS / United States
/ / European Society of Coloproctology /
/ / National Institute for Health Research (NIHR) Global Health Research Unit /

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