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

Anaesthesia - Tập 76 Số 6 - Trang 748-758 - 2021

Tóm tắt

SummaryPeri‐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.

Từ khóa


Tài liệu tham khảo

10.1016/S0140-6736(20)31182-X

10.1200/JCO.20.01933

10.1016/j.surg.2020.09.022

Economist Intelligence Unit.Coronavirus vaccines: expect delays. Q1 global forecast 2021.2021.https://www.eiu.com/n/campaigns/q1‐global‐forecast‐2021/(accessed 01/02/2021).

10.1016/S0140‐6736(21)00306-8

10.1097/ALN.0b013e3181fc6e0a

10.1097/EJA.0000000000000223

10.1097/ALN.0000000000000334

10.1002/bjs.12050

10.1002/jso.26377

Arnal VelascoS Morales‐CondeS.Recomendaciones para la programación de cirugía en condiciones de seguridad durante la pandemia COVID‐19.2020.https://www.aecirujanos.es/files/noticias/165/documentos/COVID19_Cirugia_electiva(1).pdf(accessed 03/02/2021).

AndreaA StefanoA FrancescoC et al.Gestione della Fase Pre‐Operatoria.2020.https://www.sicm.it/storage‐file/covid19/0525‐LG‐Pre‐Op‐Covid‐SICM_PDF.pdf(accessed 05/02/2021).

FrydenbergM MaddernG CollinsonT et al.Delaying surgery for patients recovering from COVID‐19: a rapid review commissioned by RACS.2021.https://www.surgeons.org/‐/media/Project/RACS/surgeons‐org/files/news/covid19‐information‐hub/2021‐01‐11‐RACS‐Post‐covid‐delay‐to‐surgery‐report.pdf(accessed 04/02/2021).

American Society of Anesthesiologists.ASA and APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID‐19 Infection.2020.https://www.asahq.org/about‐asa/newsroom/news‐releases/2020/12/asa‐and‐apsf‐joint‐statement‐on‐elective‐surgery‐and‐anesthesia‐for‐patients‐after‐covid‐19‐infection(accessed 04/02/2021).

European Association for Endoscopic Surgery and other Interventional Techniques.Preoperative testing and screening for elective surgery during the pandemic COVID‐19 to re‐start surgery.2021.https://eaes.eu/covid‐19‐statements/preoperative‐testing‐and‐screening‐for‐elective‐surgery‐during‐the‐pandemic‐covid‐19‐to‐re‐start‐surgery/(accessed 04/02/2021).

10.1016/S0140-6736(07)61602-X

World Bank.World Bank Country and Lending Groups.2021.https://datahelpdesk.worldbank.org/knowledgebase/articles/906519‐world‐bank‐country‐and‐lending‐groups(accessed 04/01/2021).

COVIDSurg Collaborative, 2020, Elective surgery cancellations due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans, British Journal of Surgery, 107, 1440

10.1136/bmj.m4087

10.1016/S1470-2045(20)30388-0

Thông tin
Thông tin xuất bản

Anaesthesia

Tập 76 Số 6

748-758

Thông tin tác giả