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

Nepogodiev, Dmitri; Simoes, Joana FF; Elizabeth, Li; Picciochi, Maria; Glasbey, James C; Baiocchi, Glauco; Blanco‐colino, Ruth; Chaudhry, Daoud; Alameer, Ehab; El‐boghdadly, Kariem; Wuraola, Funmilola; Ghosh, Dhruva; Gujjuri, Rohan R; Harrison, Ewen M; Lule, Herman; Kaafarani, Haytham; Khosravi, Mohammad; Kronberger, Irmgard; Leventoğlu, Sezai; Mann, Harvinder; Mclean, Kenneth A; Mengesha, Mengistu Gebreyohanes; Modolo, Maria Marta; Ntirenganya, Faustin; Norman, Lisa; Outani, Oumaima; Pius, Riinu; Pockney, Peter; Qureshi, Ahmad Uzair; Roslani, April Camilla; Satoi, Sohei; Shaw, Catherine; Bhangu, Aneel; Nepogodiev, Dmitri; Omar, Omar M; Ahmed, Waheed‐ul‐rahman; Argus, Leah; Ball, Alasdair; Bhangu, Aneel; Bywater, Edward P; Blanco‐colino, Ruth; Brar, Amanpreet; Chaudhry, Daoud; Dawson, Brett E; Duran, Irani; Elhadi, Muhammed; Glasbey, James C; Gujjuri, Rohan R; Jones, Conor S; Harrison, Ewen M; Kamarajah, Sivesh K; Keatley, James M; Lawday, Samuel; Elizabeth, Li; Mann, Harvinder; Marson, Ella J; Mclean, Kenneth A; Nepogodiev, Dmitri; Norman, Lisa; Ots, Riinu; Outani, Oumaima; Picciochi, Maria; Santos, Irène; Shaw, Catherine; Simoes, Joana FF; Taylor, Elliott H; Trout, Isobel M; Varghese, Chris; Venn, Mary L; William, Xu; Simoes, Joana FF; Dajti, Irida; Gjata, Arben; Kacimi, Salah Eddine Oussama; Boccalatte, Luis; Modolo, Maria Marta; Cox, Daniel; Pockney, Peter; Townend, Philip; Aigner, Felix; Kronberger, Irmgard Elisabeth; Samadov, Elgun; Alderazi, Amer; Hossain, Kamral; Padmore, Greg; Ramshorst, Gabrielle; Lawani, Ismaïl; Cerovac, Anis; Delibegovic, Samir; Baiocchi, Glauco; Gomes, Gustavo Mendonça Ataíde; Buarque, Igor Lima; Gohar, Muhammad; Slavchev, Mihail; Nwegbu, Chukwuemeka; Agarwal, Arnav; Brar, Amanpreet; Martin, Janet; Ng‐kamstra, Joshua; Modolo, Maria Marta; Olivos, Maricarmen; Lou, Wenhui; Ren, Dong‐lin; Calvache, Jose Andres; Perez Rivera, Carlos J; Hadzibegovic, Ana Danic; Kopjar, Tomislav; Mihanovic, Jakov; Jiménez, Pablo Mijahil Avilés; Gouvas, Nikolaos; Klat, Jaroslav; Novysedlák, René; Amisi, Nicolas; Christensen, Peter; El‐hussuna, Alaa; Batista, Sylvia; Lincango‐naranjo, Eddy; Emile, Sameh; Sandoval, Danilo Alfonso Arévalo; Dhufera, Hailu; Hailu, Samuel; Mengesha, Mengistu G; Kauppila, Joonas H; Arnaud, Alexis P; Demetrashvili, Zaza; Albertsmeier, Markus; Lederhuber, Hans; Löffler, Markus W.; Acquah, Daniel Kwesi; Ofori, Bernard; Tabiri, Stephen; Metallidis, Symeon; Tsoulfas, Georgios; Aguilera‐arevalo, Maria‐lorena; Recinos, Gustavo; Mersich, Tamás; Wettstein, Dániel; Ghosh, Dhruva; Kembuan, Gabriele; Milan, Peiman Brouki; Khosravi, Mohammad Hossein; Mozafari, Masoud; Hilmi, Ahmed; Mohan, Helen; Zmora, Oded; Gallo, Gaetano; Pata, Francesco; Pellino, Gianluca; Fujimoto, Yuki; Kuroda, Naoto; Satoi, Sohei; Abou Chaar, Mohamad K.; Ayasra, Faris; Fakhradiyev, Ildar; Hamdun, Intisar Hisham Said; Jin‐young, Jang; Jamal, Mohammad; Karout, Lina; Elhadi, Muhammed; Gulla, Aiste; Rasoaherinomenjanahary, Fanjandrainy; Samison, Luc Hervé; Roslani, April Camilla; Sánchez, Iran Irani Durán; Gonzalez, Diana Samantha; Martinez, Laura; Martínez, María José; Nayen, Alejandra; Medina, Antonio Ramos‐De; Nunez, Jade; Outani, Oumaima; Nashidengo, Pueya Rashid; Shah, Rakesh; Shrestha, Ashish Lal; Jonker, Pascal; Kruijff, Schelto; Noltes, Milou; Steinkamp, Pieter; Varghese, Chris; Wright, Deborah; Abdur‐rahman, Lukman; Ademuyiwa, Adesoji; Adisa, Adewale; Osinaike, Babatunde; Seyi‐olajide, Justina; Williams, Omolara; Williams, Emmanuel; Pejkova, Sofija; Al Balushi, Zainab; Qureshi, Ahmad Uzair; Sayyed, Raza; Mohsen, Mustafa Abo; Abukhalaf, Sadi A.; Cukier, Moises; Gomez‐fernandez, Hugo; Yip, Sebastian Shu; Ojeda, Ximena Paola Vasquez; Sacdalan, Marie Dione; Major, Piotr; Azevedo, José; Cunha, Miguel F.; Santos, Irène; Zarour, Ahmad; Bonci, Eduard‐alexandru; Negoi, Ionut; Efetov, Sergey; Kochetkov, Viktor; Litvin, Andrey; Ingabire, Jc Allen; Bucyibaruta, Georges; Faustin, Ntirenganya; Habumuremyi, Sosthene; Imanishimwe, Alphonsine; Dieu, Haragirimana Jean; Munyaneza, Emmanuel; Ncogoza, Isaie; Alameer, Ehab; Ndong, Abdourahmane; Radenkovic, Dejan; Chew, Min Hoe; Koh, Frederick; Ngu, James; Panyko, Arpád; Bele, Uros; Košir, Jurij Aleš; Daoud, Hassan; Blanco‐colino, Ruth; Bravo, Ana Maria Minaya; Jayarajah, Umesh; Wickramasinghe, Dakshitha; Adam, Mohammed Elmujtba Adam Essa; Rutegård, Martin; Sund, Malin; Adamina, Michel; Gialamas, Eleftherios; Horisberger, Karoline; Alshaar, Muhammad; Huang, Abel; Lohsiriwat, Varut; Charles, Shane; Jlassi, Haithem; Isik, Arda; Leventoğlu, Sezai; Lekuya, Hervé Monka; Lekuya, Hervé Monka; Lule, Herman; Kopetskyi, Slava; Alsaadi, Hayder; Alshryda, Sattar; Alser, Osaid; Bankhead‐kendall, Brittany; Breen, Kerry; Kaafarani, Haytham; Mashbari, Hassan; Cal, Fernando Bonilla; Al‐naggar, Hamza; Maimbo, Mayaba; Mazingi, Dennis; Abbott, Tom; Adamina, Michel; Akhbari, Melika; Benson, Ruth; Bhanderi, Shivam; Biccard, Bruce; Caruana, Edward; Chakrabortee, Sohini; Chapatwala, Reema; Costas‐chavarri, Ainhoa; Demetriades, Andreas K; Desai, Anant; Di Saverio, Salomone; Drake, Thomas; Edwards, John; Evans, Jonathan; Fiore, Marco; Ford, Samuel; Fotopoulou, Christina; Fowler, Alexander; Futaba, Kaori; Ganly, Ian; James, Harelimana Grace; Griffiths, Ewen; Gronchi, Alessandro; Hutchinson, Peter; Hyman, Gabriella Yael; Incorvia, Joseph; Jain, Ritu; Jenkinson, Michael; Khan, Tabassum; Knight, Stephen Richard; Kolias, Angelos; Kudsk‐iversen, Søren; Kwan, Tsun Yu; Leung, Elaine; Mayol, Julio; Mckay, Siobhan; Meara, John G.; Mills, Emily; Moug, Susan; Patel, Akshay; Perinotti, Roberto; Rice, Henry E.; Roberts, Keith; Schache, Andrew; Shaw, Richard; Smart, Neil; Stephens, Matthew; Stewart, Grant D.; Teasdale, Ella; Vaughan‐shaw, Peter; Vidya, Raghavan; Wright, Naomi; Wuraola, Funmilola; Zimmelman, Natalie; Agastra, Ervis; Thereska, Dariel; Carnevali, Adriano; Carpino, Antonio; Cristofaro, Maria Giulia; De Paola, Gilda; Giannaccare, Giuseppe; Novembre, Daniela; Sammarco, Giuseppe; Scorcia, Vincenzo; Yu, Angeli Christy; Lacavalla, Domenico; Occhionorelli, Savino; Rubbini, Michele; Massimiliano, Bernabei; Fabbri, Nicolò; Fazzin, Marta; Feo, Carlo; Torchiaro, Marco

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.