Studies show that surgery should be delayed for at least 7 weeks after COVID-19 diagnosis to reduce the risk of death

New international research presented at anesthesia Patients test positive for SARS-CoV-2 because data show that surgery performed between 0 and 6 weeks after diagnosis is associated with an increase, according to the Journal of the British Association of Anesthesiology of Ireland. After that, he concludes that surgery should be delayed for 7 weeks. death.

This study is by COVIDSurg Collaborative. A global collaboration of over 15,000 surgeons working together to collect a variety of data on the COVID-19 pandemic. The lead authors of this study are Dr. Dmitri Nepogodiev (Public Health) and Dr. Aneel Bhangu (Surgeon) at the University of Birmingham, UK.

Infection with SARS-CoV-2 during surgery is known to increase mortality, and international guidelines recommend delaying surgery for COVID-19-positive patients, but with regard to the optimal delay period. There is little evidence.

This international multicenter study included 140,231 patients (1,674 hospitals, 116 countries) * who underwent surgery in October 2020. Participating hospitals included all patients who underwent surgery. Due to the number of co-authors (more than 15,000), this is the largest collaborative surgery study ever done in the world.

Patients infected with SARS-CoV-2 after surgery were excluded from the study. The primary outcome indicator was death 30 days after surgery. Statistical modeling was used to adjust patient, disease, and surgical variables to calculate adjusted 30-day mortality from SARS-CoV-2 for different time periods. Diagnosis For surgery.

The time from diagnosis to surgery for SARS-CoV-2 is 0 to 2 weeks for 1,144 (0.8%) patients, 3 to 4 weeks for 461 (0.3%), and 5 to 6 for 327 (0.2%). It was more than 7 weeks a week. There were no SARS-CoV-2 infections in 1,205 (0.9%) and 137,590 (97.8%) patients. Adjusted 30-day mortality for patients without SARS-CoV-2 infection was 1.5%. This increased in patients who underwent surgery at 0-2 weeks (4.0%), 3-4 weeks (4.0%), and 5-6 weeks (3.6%), but 7-8 weeks after SARS (3-8%). 1.5%) did not increase. CoV-2 diagnosis.

These findings were consistent across age groups, patient health levels, surgical urgency (selective vs. urgent), and surgical grade (minor vs. major). After a delay of 7 weeks or more, patients with ongoing COVID-19 symptoms (6.0%) had a higher mortality rate than patients with symptoms resolved (2.4%) or asymptomatic patients (1.3%). ..

Dr. Dmitri Nepogodiev said: “Patients who underwent surgery 0-6 weeks after the diagnosis of SARS-CoV-2 infection were found to be at increased risk of postoperative death, as were patients who continued to have symptoms at the time of surgery. Surgery is recommended. If you have symptoms that persist for at least 7 weeks after a positive SARS-CoV-2 test, or for more than 7 weeks after diagnosis, you should delay until the symptoms disappear. There is. “

Dr. Aneel Bhangu adds: “The possible benefits of delaying surgery for at least 7 weeks after SARS-CoV-2 diagnosis need to be balanced with the potential risk of delay, so decisions regarding delay in surgery need to be tailored on a patient-by-patient basis. In surgery such as advanced tumors, surgeons and patients may determine that the risk of delay is not justified. “

Dr. Mike Nathanson, President of the Society of Anesthesiology, said: “This treatise provides important information to patients and their caregivers and helps determine the appropriate time for surgery after COVID-19 infection. SurgeryMany people are infected with COVID-19 and would like to be informed about the risks. COVID-19 has been with us for many years and the number of previously infected patients will continue to grow. ”

Provided by AAGBI