University of Oulu

COVIDSurg Collaborative, GlobalSurg Collaborative, Nepogodiev, D., Simoes, J. F., Li, E., Picciochi, M., Glasbey, J. C., Baiocchi, G., Blanco‐Colino, R., Chaudhry, D., AlAmeer, E., El‐Boghdadly, K., Wuraola, F., Ghosh, D., Gujjuri, R. R., Harrison, E. M., Lule, H., Kaafarani, H., Khosravi, M., … Mutambanengwe, P. G. T. (2021). Timing of surgery following SARS‐CoV‐2 infection: An international prospective cohort study. Anaesthesia, 76(6), 748–758.

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

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Author: COVIDSurg Collaborative; GlobalSurg Collaborative
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2022-03-30


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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Series: Anaesthesia
ISSN: 0003-2409
ISSN-E: 1365-2044
ISSN-L: 0003-2409
Volume: 76
Issue: 6
Pages: 748 - 758
DOI: 10.1111/anae.15458
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: 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.
Copyright information: © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.