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

Abstract

[EN]Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determinethe optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. Thisinternational, multicentre, prospective cohort study included patients undergoing elective or emergencysurgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared withthose without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperativemortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by timefrom 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-2infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality wasincreased 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 ahigher 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 delayedfor at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms≥7 weeks from diagnosismay benefit from further dela