期刊
ANAESTHESIA
卷 76, 期 6, 页码 748-758出版社
WILEY
DOI: 10.1111/anae.15458
关键词
COVID-19; delay; SARS-CoV-2; surgery; timing
资金
- RCS Covid Research Group
- National Institute for Health Research (NIHR) Global Health Research Unit
- Association of Coloproctology of Great Britain and Ireland
- Bowel and Cancer Research
- Bowel Disease Research Foundation
- Association of Upper Gastrointestinal Surgeons
- British Association of Surgical Oncology
- British Gynaecological Cancer Society
- European Society of Coloproctology
- Medtronic
- NIHR Academy
- Sarcoma UK
- Urology Foundation
- Vascular Society for Great Britain and Ireland
- Yorkshire Cancer Research
- National Institute for Health Research [NIHR300175] Funding Source: researchfish
The study suggests that surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection, with patients experiencing ongoing symptoms >= 7 weeks from diagnosis potentially benefitting from further delay.
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.
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