TY - JOUR
T1 - Timing of surgery following SARS-CoV-2 infection
T2 - an international prospective cohort study
AU - COVIDSurg Collaborative
AU - GlobalSurg Collaborative
AU - Study group members AMC, null
AU - Bakx, Roel
AU - Besselink, Marc G. H.
AU - Lemmers, Daan H. L.
AU - Roelofs, Anne
AU - van Amstel, Paul
AU - van Helsdingen, Claire P. M.
N1 - Appendix 2: extract Netherlands: Eva Berkeveld, Frank Bloemers, Alexander Borgstein, Suzanne Gisbertz, Sarah Mikdad, Mark van Berge Henegouwen (Amsterdam UMC VUmc, Amsterdam); Roel Bakx, Marc Besselink, Daniel HL Lemmers, Anne-Jasmin Roelofs, Paul van Amstel, Claire van Helsdingen (Amsterdam UMC, University of Amsterdam, Amsterdam); Ludi Smeele (Antoni van Leeuwenhoek ziekenhuis, Amsterdam); Niels Harlaar, Frederik Jonker, Sjirk van der Burg, Justin Y. van Oostendorp (Rode Kruis Ziekenhuis, Beverwijk); Saranda Ombashi, Tim van der Voort, Martijn van Geldorp (Amphia, Breda); Lisanne Posma-Bouman (Slingeland Ziekenhuis, Doetinchem); Hans Donald de Boer, Annette Olieman, Henriette Smid-Nanninga (Martini General Hospital Groningen, Groningen); Jean-Paul P.M. De Vries, Rianne Hogenbirk, Schelto Kruijff, Milou Noltes, Pieter Steinkamp (University Medical Center Groningen, Groningen); Tyche Derksen, Josephine Franken, Steven Oosterling (Spaarne Gasthuis, Haarlem); Peter Nolte, Jelle van der List (Spaarne Gasthuis, Hoofddorp); Ian Alwayn, Okker Bijlstra, Andries Braat, Ruth Bulder, Michèle de Kok, Robin Faber, Ben Goudsmit, Jaap Hamming, Sven Mieog, Alexander Vahrmeijer, Fenna E.M. van de Leemkolk, Joost van der Vorst, Jan van Schaik, Merel Verhagen (Leiden University Medical Center, Leiden); Kim Albers, Larsa Gawria, Harry Van Goor, Michiel Warle (Radboud Universitair Medisch Centrum, Nijmegen); Tessa M. van Ginhoven, Charlotte Viëtor (Erasmus MC Cancer Institute, Rotterdam); Evert-Jan Boerma, Lara Lallitsch, Donald Schweitzer (Zuyderland Medical Centre, Sittard/Heerlen); Wouter Leclercq, Julie Sijmons, Peter-Jan Vancoillie (Máxima Medical Center, Veldhoven); Joop Konsten, Maarten van Heinsbergen (VieCuri Medisch Centrum, Venlo); Nicole Dekker, Frank den Boer (Zaans Medisch Centrum, Zaandam). Funding Information: Trial registration at clinicaltrials.gov (NCT04509986). The authors would like to thank the RCS Covid Research Group for their support. Funding was provided by: the National Institute for Health Research (NIHR) Global Health Research Unit; Association of Coloproctology of Great Britain and Ireland; Bowel and Cancer Research; Bowel Disease Research Foundation; Association of Upper Gastrointestinal Surgeons; British Association of Surgical Oncology; British Gynaecological Cancer Society; European Society of Coloproctology; Medtronic; NIHR Academy; Sarcoma UK; the Urology Foundation; Vascular Society for Great Britain and Ireland; and Yorkshire Cancer Research. The views expressed are those of the authors and not necessarily those of the funding partners. No other competing interests. Publisher Copyright: © 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
UR - http://www.scopus.com/inward/record.url?scp=85102236123&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/anae.15458
DO - https://doi.org/10.1111/anae.15458
M3 - Article
C2 - 33690889
SN - 0003-2409
VL - 76
SP - 748
EP - 758
JO - Anaesthesia
JF - Anaesthesia
IS - 6
ER -