Megan Folsom, MD, MS, MS, CCC/SLP
The University of Kansas Health System
Kansas City
Disclosure information not submitted.
Title: Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
Introduction: The rise of SARS-CoV-2 has presented unique perioperative challenges. A previous study examining surgical outcomes of 36,000 patients diagnosed with perioperative SARS-CoV-2 infection found that 51% of patients experienced a postoperative pulmonary complication and 24% died within 30 days of surgery. Further analysis and risk stratification was limited due to lack of current research. Results of a study in patients with operable cancer found comparable outcomes. The primary aim of this study was to discover when perioperative complication risk is sufficiently minimized in patients with a previous SARS-CoV-2 diagnosis.
Methods: 30-day post-operative mortality was the primary measure comparing outcomes of patients with confirmed SARS-CoV-2 infection and patients who tested negative for SARS-CoV-2 before surgery. Secondary measures included 30-day post-operative pulmonary complications, venous thromboembolism, Clavien-Dindo grade, and in-patient mortality.
Results: As part of a large international study, the University of Kansas Medical Center GlobalSurg team contributed data on 41 eligible patients. Three patients had a SARS-CoV-2 diagnosis prior to surgery (7%) and were alive 30 days postoperatively without experiencing any post-operative complications. Globally, 2% of patients tested positive for SARS-CoV-2 prior to surgery, 2.8% experienced postoperative complications, and 30-day postoperative mortality was 1.5%. The analysis showed patients having surgery within six weeks of a SARS-CoV-2 diagnosis had an increased risk of postoperative pulmonary complications and mortality. These risks decreased to the level of the negative-testing cohort if surgery was delayed to at least seven weeks post-infection. When adjusted for age and pre-existing risk (per ASA physical status), these findings remain consistent across all groups.
Conclusions: This is the first study to provide substantial data indicating optimal timing of surgery following SARS-CoV-2 infection and consistent with other study data, with overall postoperative morbidity and mortality decreased if surgery is delayed to least seven weeks post-infection. This is longer than the typical delay of 4 weeks for a patient with presumed upper airway reactivity and subsequent guidelines have been updated for patients with SARS-CoV-2 viral infections.