Timing of Elective Surgery after COVID19
Perioperative morbidity and mortality are increased in patients with COVID19. Two recent studies investigated the outcome and optimal timing for elective surgery after being infected with SARS-CoV-2.
A study from the University of California Davis in Sacramento compared the clinical outcomes for 5,470 patients who tested positive for COVID19 infection and a matched sample of 5,470 patients who tested negative between April 1 and Nov. 30, 2020. Patients who underwent gynecologic, obstetrical, or minor procedures were excluded.Patients with Sars-CoV-2 infection had a mortality rate of 14.8% compared to 7.1%in noninfected patients. There were no significant differences noted between the two groups for rates of complications listed in the Vizient Clinical Data Base nor median length of stay. However, patients with COVID19 had more hospital-acquired conditions and patient safety indicators. No differences in mortality rates, complications, hospital-acquired conditions, or patient safety indicators were observed between COVID19 surgical patients treated at public, private, or nonprofit hospitals.
The study concluded that people with COVID19 had more than double the mortality risk. The authors suggested postponing surgeries whenever possible for patients with preoperative positive SARS-CoV-2 tests results.
A second prospective international study from the GlobalSurg Collaborative investigated 140,231 patients in 116 countries who underwent elective or emergency surgery during October 2020. Of that total, 3137 patients tested positive for SARS-CoV-2 preoperatively. The primary outcome was 30-day postoperative mortality. Thirty-day mortality was 1.5% in patients without SARS-CoV-2 infection. In patients with preoperative SARS-CoV-2 infection, mortality was 4.1% in patients having surgery within 0-2 weeks, 3.9% at 3-4 weeks and 3.6% at 5-6 weeks. Patients who recovered from infection and had surgery 7 weeks or more after SARS-CoV-2 infection had the same mortality rate as uninfected patients. Patients with ongoing symptoms who had surgery 7 or more weeks later had a 6% mortality rate.
Patients with COVID19 who had surgery <7 weeks from the diagnosis had a three- to four-fold increase in 30-day mortality compared with uninfected patients. Mortality risk returned to baseline when surgery was performed 7 weeks or more after diagnosis, except in patients with ongoing COVID19 symptoms. The authors concluded that elective surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients who still had ongoing symptoms would benefit from an even longer delay.
References
Haffner MR, et al. Postoperative in-hospital morbidity and mortality of patients with COVID-19 infection compared with patients without COVID-19 infection. JAMA Network Open. April 12, 2021;4(4):e215697. doi:10.1001/jamanetworkopen.2021.5697
COVIDSurg Collaborative, GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia, March 9, 2021, https://doi.org/10.1111/anae.15458
