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.

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study / ), ; Alberici, Laura; Antonacci, Filippo; Arena, Alessandro; Belvedere, Angela; Bernagozzi, Fabio; Bernante, Paolo; Bertoglio, Pietro; Bianchi, Lorenzo; Bisulli, Maria; Bonfanti, Barbara; Boussedra, Safia; Brandolini, Jury; Cacciapuoti, Crescenzo; Cardelli, Stefano; Casadei, Riccardo; Cescon, Matteo; Cipolli, Alessandro; Cipriani, Riccardo; Contu, Luca; Costa, Francesco; Daddi, Niccolo’; De Crescenzo, Eugenia; De Iaco, Pierandrea; De Palma, Alessandra; Del Gaudio, Massimo; Nunzia Della Gatta, Anna; Dolci, Giampiero; Dondi, Giulia; Droghetti, Matteo; Nicola Forti Parri, Sergio; Garelli, Elena; Gelati, Chiara; Germinario, Giuliana; Giorgini, Federico A.; Ingaldi, Carlo; Jovine, Elio; Kawamukai, Kenji; Lanci Lanci, Antonio; Lombardi, Raffaele; Lozano Miralles, Maria Elisa; Marchetti, Claudio; Masetti, Michele; Minni, Francesco; Morezzi, Daniele; Parlanti, Daniele; Pellegrini, Alice; Myriam Perrone, Anna; paola Pezzuto, Anna; Pignatti, Marco; Pilu, Gianluigi; Pinto, Valentina; Poggioli, Gilberto; Bernadetta Puglisi, Silvana; Raimondo, Diego; Ravaioli, Matteo; Ricci, Claudio; Ricciardi, Sara; Ricotta, Francesco; Rizzo, Roberta; Romano, Angela; Rottoli, Matteo; Schiavina, Riccardo; Seracchioli, Renato; Serenari, Matteo; Serra, Margherita; Solli, Piergiorgio; Sorbi, Gioia; Taffurelli, Mario; Tanzanu, Marta; Tarsitano, Achille; Tesei, Marco; Vago, Gabriele; Violante, Tommaso; Zanotti, Simone; Frisoni, Tommaso; Solaini, Leonardo; Ercolani, Giorgio. - In: ANAESTHESIA. - ISSN 0003-2409. - 76:6(2021), pp. 748-758. [10.1111/anae.15458]

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

Safia Boussedra;Luca Contu;Elio Jovine;Maria Elisa Lozano Miralles;Claudio Marchetti;Francesco Minni;Marco Pignatti;Valentina Pinto;
2021

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.
2021
76
6
748
758
Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study / ), ; Alberici, Laura; Antonacci, Filippo; Arena, Alessandro; Belvedere, Angela; Bernagozzi, Fabio; Bernante, Paolo; Bertoglio, Pietro; Bianchi, Lorenzo; Bisulli, Maria; Bonfanti, Barbara; Boussedra, Safia; Brandolini, Jury; Cacciapuoti, Crescenzo; Cardelli, Stefano; Casadei, Riccardo; Cescon, Matteo; Cipolli, Alessandro; Cipriani, Riccardo; Contu, Luca; Costa, Francesco; Daddi, Niccolo’; De Crescenzo, Eugenia; De Iaco, Pierandrea; De Palma, Alessandra; Del Gaudio, Massimo; Nunzia Della Gatta, Anna; Dolci, Giampiero; Dondi, Giulia; Droghetti, Matteo; Nicola Forti Parri, Sergio; Garelli, Elena; Gelati, Chiara; Germinario, Giuliana; Giorgini, Federico A.; Ingaldi, Carlo; Jovine, Elio; Kawamukai, Kenji; Lanci Lanci, Antonio; Lombardi, Raffaele; Lozano Miralles, Maria Elisa; Marchetti, Claudio; Masetti, Michele; Minni, Francesco; Morezzi, Daniele; Parlanti, Daniele; Pellegrini, Alice; Myriam Perrone, Anna; paola Pezzuto, Anna; Pignatti, Marco; Pilu, Gianluigi; Pinto, Valentina; Poggioli, Gilberto; Bernadetta Puglisi, Silvana; Raimondo, Diego; Ravaioli, Matteo; Ricci, Claudio; Ricciardi, Sara; Ricotta, Francesco; Rizzo, Roberta; Romano, Angela; Rottoli, Matteo; Schiavina, Riccardo; Seracchioli, Renato; Serenari, Matteo; Serra, Margherita; Solli, Piergiorgio; Sorbi, Gioia; Taffurelli, Mario; Tanzanu, Marta; Tarsitano, Achille; Tesei, Marco; Vago, Gabriele; Violante, Tommaso; Zanotti, Simone; Frisoni, Tommaso; Solaini, Leonardo; Ercolani, Giorgio. - In: ANAESTHESIA. - ISSN 0003-2409. - 76:6(2021), pp. 748-758. [10.1111/anae.15458]
), ; Alberici, Laura; Antonacci, Filippo; Arena, Alessandro; Belvedere, Angela; Bernagozzi, Fabio; Bernante, Paolo; Bertoglio, Pietro; Bianchi, Lorenzo; Bisulli, Maria; Bonfanti, Barbara; Boussedra, Safia; Brandolini, Jury; Cacciapuoti, Crescenzo; Cardelli, Stefano; Casadei, Riccardo; Cescon, Matteo; Cipolli, Alessandro; Cipriani, Riccardo; Contu, Luca; Costa, Francesco; Daddi, Niccolo’; De Crescenzo, Eugenia; De Iaco, Pierandrea; De Palma, Alessandra; Del Gaudio, Massimo; Nunzia Della Gatta, Anna; Dolci, Giampiero; Dondi, Giulia; Droghetti, Matteo; Nicola Forti Parri, Sergio; Garelli, Elena; Gelati, Chiara; Germinario, Giuliana; Giorgini, Federico A.; Ingaldi, Carlo; Jovine, Elio; Kawamukai, Kenji; Lanci Lanci, Antonio; Lombardi, Raffaele; Lozano Miralles, Maria Elisa; Marchetti, Claudio; Masetti, Michele; Minni, Francesco; Morezzi, Daniele; Parlanti, Daniele; Pellegrini, Alice; Myriam Perrone, Anna; paola Pezzuto, Anna; Pignatti, Marco; Pilu, Gianluigi; Pinto, Valentina; Poggioli, Gilberto; Bernadetta Puglisi, Silvana; Raimondo, Diego; Ravaioli, Matteo; Ricci, Claudio; Ricciardi, Sara; Ricotta, Francesco; Rizzo, Roberta; Romano, Angela; Rottoli, Matteo; Schiavina, Riccardo; Seracchioli, Renato; Serenari, Matteo; Serra, Margherita; Solli, Piergiorgio; Sorbi, Gioia; Taffurelli, Mario; Tanzanu, Marta; Tarsitano, Achille; Tesei, Marco; Vago, Gabriele; Violante, Tommaso; Zanotti, Simone; Frisoni, Tommaso; Solaini, Leonardo; Ercolani, Giorgio
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