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

Building on our prior global work with GlobalSurg, the MEDICI Centre served as a global and national lead to help design, implement and disseminate a number of studies throughout the COVID pandemic. The largest study, entitled GlobalSurg-CovidSurg-Week,  enrolled over 140,000 patients from 1674 hospitals in 116 countries, making this the largest ever prospective international surgical study. The first paper from this study, on the timing of surgery after SARS-CoV-2 infection, has now been published. The key finding is that perioperative mortality falls to baseline when surgery occurs at 7 or more weeks after SARS-CoV-2 infection. However, for those patients who have ongoing symptoms at that time, risk remains elevated and so they may benefit from further delay in surgery if the clinical context allows. 

A Message of Thanks from  Janet Martin, on behalf of COVIDSurg Canada and the MEDICI Team:
A heartfelt thanks to Jessica Moodie, Amy Sterkenburg, Eunice Chan, Decision Support, and the REB team who helped to administer this study within short timeframes, and also all of you who volunteered to collect data for this study during a very busy Oct/Nov (699 consecutive surgical patients from LHSC):

Co-authors from LHSC: Hilda Alfaro, Nawar Alkhamesi, Laura Allen, Muriel Brackstone, Eunice Chan, Davy Cheng, Jason Chui, Nelson Gonzalez, Brent Lanting, S. Danielle MacNeil, Janet Martin, Robert Mayer, Jacob McGee, Mahesh Nagappa, Nicholas Power, Agya Prempeh, Mehdi Qiabi, Hassan Razvi, Emil Schemitsch, Herman Sehmbi, Ushma Shah, Yamini Subramani, Edward Vasarhelyi, Kelly Vogt, Homer Yang. The full list of co-authors is here.

Again, thanks to all, and congratulations- this is a huge global accomplishment, with highly relevant results of immediate relevance for clinical practice as we ramp up surgery while the virus still circulates.

COVIDSurg Collaborative, GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia 2021. 

Summary: 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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