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

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@article{a94331bb0e1b4bb3b38ebb5abf2ee646,
title = "Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study",
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.",
keywords = "COVID-19, SARS-CoV-2, delay, surgery, timing, Prospective Studies, Humans, Middle Aged, Child, Preschool, Infant, Male, Time, Surgical Procedures, Operative/statistics & numerical data, Young Adult, Internationality, Adolescent, Aged, 80 and over, Adult, Female, Aged, Child, Cohort Studies, Practice Guidelines as Topic",
author = "{COVIDSurg Collaborative} and Meyhoff, {Christian Sylvest} and Bonde Peter and Ebbeh{\o}j, {Anders Lyng} and J{\o}rgensen, {Lars Nannestad} and Peter-Martin Krarup and Anne-Louise Lihn and Henrik Palm and Schlesinger, {Nis Hallundb{\ae}k} and Smith, {Henry George} and Anne-Sofie Fenger and Haugstvedt, {Aleksander Fjeld} and Hansen, {Christine Hangaard} and J{\"o}nsson, {Maria Lovisa} and Otte, {Helena Roed} and Amar, {Anas Ould Si} and Ida Tryggedsson",
note = "{\textcopyright} 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.",
year = "2021",
month = jun,
doi = "10.1111/anae.15458",
language = "English",
volume = "76",
pages = "748--758",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "6",

}

RIS

TY - JOUR

T1 - Timing of surgery following SARS-CoV-2 infection

T2 - an international prospective cohort study

AU - COVIDSurg Collaborative

A2 - Meyhoff, Christian Sylvest

A2 - Peter, Bonde

A2 - Ebbehøj, Anders Lyng

A2 - Jørgensen, Lars Nannestad

A2 - Krarup, Peter-Martin

A2 - Lihn, Anne-Louise

A2 - Palm, Henrik

A2 - Schlesinger, Nis Hallundbæk

A2 - Smith, Henry George

A2 - Fenger, Anne-Sofie

A2 - Haugstvedt, Aleksander Fjeld

A2 - Hansen, Christine Hangaard

A2 - Jönsson, Maria Lovisa

A2 - Otte, Helena Roed

A2 - Amar, Anas Ould Si

A2 - Tryggedsson, Ida

N1 - © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

PY - 2021/6

Y1 - 2021/6

N2 - 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.

AB - 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.

KW - COVID-19

KW - SARS-CoV-2

KW - delay

KW - surgery

KW - timing

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Child, Preschool

KW - Infant

KW - Male

KW - Time

KW - Surgical Procedures, Operative/statistics & numerical data

KW - Young Adult

KW - Internationality

KW - Adolescent

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Aged

KW - Child

KW - Cohort Studies

KW - Practice Guidelines as Topic

UR - http://www.scopus.com/inward/record.url?scp=85102236123&partnerID=8YFLogxK

U2 - 10.1111/anae.15458

DO - 10.1111/anae.15458

M3 - Journal article

C2 - 33690889

VL - 76

SP - 748

EP - 758

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 6

ER -

ID: 64185134