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 / Prucher, Gian Marco; Assenza, Marco; Binda, Barbara; Biondi, Massimo; Brachini, Gioia; Bruzzaniti, Placido; Mauro, Casagrande; Flavia, Ciccarone; Cicerchia, Pierfranco Maria; Cirillo, Bruno; Crocetti, Daniele; D'Ambrosio, Giancarlo; D'Andrea, Vito; De Felice, Francesca; De Toma, Giorgio; Della Rocca, Carlo; Giulia, Duranti; Familiari, Pietro; Fiori, Enrico; Fonsi, Giovanni Battista; Frati, Alessandro; La Rocca, Stefania; Pierfrancesco, Lapolla; Marino, Davide; Marruzzo, Giovanni; Meneghini, Simona; Mingoli, Andrea; Pata, Francesco; Picchetto, Andrea; Polimeni, Antonella; Ribuffo, Diego; Salvati, Maurizio; Santoro, Antonio; Sapienza, Paolo; Luigi, Simonelli; Valentini, Valentino; Zambon, Martina; Zancana, Giuseppa; Emma, Zuppi; Trungu, Sokol; Cinquepalmi, Matteo; D'Annunzio, Simone; De Nunzio, Cosimo; Fiorelli, Silvia; Ibrahim, Mohsen; Loffredo, Chiara; Massullo, Domenico; Menna, Cecilia; Rocco, Monica; Pelli, Massimiliano; Rendina, Erino Angelo; Teodonio, Leonardo; Tubaro, Andrea. - 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

prucher
Primo
;
Marco Assenza
Secondo
;
Barbara Binda;Massimo Biondi
;
Gioia Brachini;Placido Bruzzaniti;Pierfranco Maria Cicerchia;Bruno Cirillo;Daniele Crocetti;Giancarlo D’ambrosio;Vito D’andrea
;
Francesca De Felice;Giorgio De Toma;Carlo Della Rocca
;
Pietro Familiari;Enrico Fiori
;
Giovanni Battista Fonsi;Alessandro Frati;Stefania La Rocca;Davide Marino;Giovanni Marruzzo;Simona Meneghini;Andrea Mingoli
;
Francesco Pata;Andrea Picchetto;Antonella Polimeni
;
Diego Ribuffo
;
Maurizio Salvati;Antonio Santoro
;
Paolo Sapienza;Valentino Valentini
;
Martina Zambon;Giuseppa Zancana;Sokol Trungu;Matteo Cinquepalmi;Simone D’Annunzio;Cosimo De Nunzio;Silvia Fiorelli;Mohsen Ibrahim
;
Chiara Loffredo;Domenico Massullo;Cecilia Menna;Rocco Monica
;
Massimiliano Pelli;Erino Angelo Rendina
;
Leonardo Teodonio
Penultimo
;
Andrea Tubaro
Ultimo
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.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11573/1515475
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