Contributors: 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 Gebreyohane; 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; Omar, Omar M; Ahmed, Waheed‐ul‐rahman; Argus, Leah; Ball, Alasdair; Bywater, Edward P; Brar, Amanpreet; Dawson, Brett E; Duran, Irani; Elhadi, Muhammed; Jones, Conor S; Kamarajah, Sivesh K; Keatley, James M; Lawday, Samuel; Marson, Ella J; Ots, Riinu; Santos, Irène; Taylor, Elliott H; Trout, Isobel M; Varghese, Chri; Venn, Mary L; William, Xu; Dajti, Irida; Gjata, Arben; Kacimi, Salah Eddine Oussama; Boccalatte, Lui; Cox, Daniel; Townend, Philip; Aigner, Felix; Kronberger, Irmgard Elisabeth; Samadov, Elgun; Alderazi, Amer; Hossain, Kamral; Padmore, Greg; Ramshorst, Gabrielle; Lawani, Ismaïl; Cerovac, Ani; Delibegovic, Samir; Gomes, Gustavo Mendonça Ataíde; Buarque, Igor Lima; Gohar, Muhammad; Slavchev, Mihail; Nwegbu, Chukwuemeka; Agarwal, Arnav; Martin, Janet; Ng‐kamstra, Joshua
نبذة مختصرة : 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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