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

Nepogodiev, D; Cammarata, E; Campanella, S; Canzonieri, D; Cordova, A; De Michele, F; Dinoto, E; Franza, M; Licari, L; Matta, D; Mirabella, D; Pecoraro, F; Pirrello, R; Pierfrancesco, P; Rosatti, F; Salamone, G; Toia, F; Tripoli, M

doi:10.1111/anae.15458

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.

Nepogodiev D, E.C. (2021). Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. ANAESTHESIA.

Data di pubblicazione:	2021
Titolo:	Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
Autori:	Nepogodiev D (Corresponding) CAMMARATA, Emanuele [Membro del Collaboration Group] CAMPANELLA, Sofia [Membro del Collaboration Group] CANZONIERI, Daniela [Membro del Collaboration Group] CORDOVA, Adriana [Membro del Collaboration Group] DE MICHELE, Federico [Membro del Collaboration Group] DINOTO, Ettore [Membro del Collaboration Group] FRANZA, Mara [Membro del Collaboration Group] LICARI, Leo [Membro del Collaboration Group] MATTA, Daniele [Membro del Collaboration Group] MIRABELLA, Domenico [Membro del Collaboration Group] PECORARO, Felice [Membro del Collaboration Group] PIRRELLO, Roberto [Membro del Collaboration Group] Pierfrancesco Pugliese [Membro del Collaboration Group] ROSATTI, Fernando [Membro del Collaboration Group] SALAMONE, Giuseppe [Membro del Collaboration Group] TOIA, Francesca [Membro del Collaboration Group] TRIPOLI, Massimiliano [Membro del Collaboration Group] mostra contributor esterni nascondi contributor esterni
Citazione:	Nepogodiev D, E.C. (2021). Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. ANAESTHESIA.
Rivista:	ANAESTHESIA
Digital Object Identifier (DOI):	http://dx.doi.org/10.1111/anae.15458
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.
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