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Adjusted 30-day postoperative mortality rates in patients with pre-operative SARS-CoV-2 infection stratified by COVID-19 symptoms. The time-periods relate to the timing of surgery following the diagnosis of SARS-CoV-2 infection. Full models and results are available in online Supporting Information (Appendix S1, Tables S7-S8).
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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. Su...
Contexts in source publication
Context 1
... had resolved or who had been asymptomatic (Fig. 3). Following a ≥ 7-week delay between SARS-CoV-2 infection and surgery, patients with ongoing COVID-19 symptoms had a higher mortality rate than patients whose symptoms had resolved or who had been asymptomatic (Fig. 3). However, patients who had surgery ≥ 7 weeks after SARS-CoV-2 infection had similar rates of postoperative pulmonary ...
Context 2
... had resolved or who had been asymptomatic (Fig. 3). Following a ≥ 7-week delay between SARS-CoV-2 infection and surgery, patients with ongoing COVID-19 symptoms had a higher mortality rate than patients whose symptoms had resolved or who had been asymptomatic (Fig. 3). However, patients who had surgery ≥ 7 weeks after SARS-CoV-2 infection had similar rates of postoperative pulmonary complications as patients without SARS-CoV-2 infection (Fig. 4). Among patients operated ≥ 7 following SARS-CoV-2 diagnosis, those with ongoing COVID-19 symptoms were at greatest risk of 30-day postoperative pulmonary ...
Similar publications
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determinethe optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. Thisinternational, multicentre, prospective cohort study included patients undergoing elective or emergencysurgery during October 2020. Surgi...
Background:
We sought to assess whether persistent COVID-19 symptoms beyond 6 months (Long-COVID) among patients with mild COVID-19 is associated with poorer health status, quality of life, and psychological distress.
Methods:
This was a multicenter prospective cohort study that included adult outpatients with acute COVID-19 from eight sites dur...
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. Su...
Citations
... Kovoor et al. recommend 8-12-week delay post COVID-19 diagnosis [8], whereas a study conducted by Bryant et al. found that there was a 1% reduction in risk of developing postoperative complications for every 10 day delay [9]. Another study found that patients operated on within 6 weeks of a COVID-19 diagnosis were at an increased risk of 30-day postoperative mortality and 30-day postoperative pulmonary complications [10]. ...
... Our results show that the risk of pulmonary complications, surgical site infections, and reoperations is decreased when surgery is delayed for or more than or equal to 17 days following a COVID-19 diagnosis. This is aligned with earlier studies that report increased risks of postoperative complications shortly after COVID-19 infection [6,10,14,15]. Despite being paramount for controlling COVID-19, the timing to surgery had a stronger independent impact on postoperative outcomes than vaccination status. ...
Introduction
The COVID-19 pandemic introduced challenges including delaying elective surgery. For cancer patients, reducing delays is preferred to prevent unfavorable outcomes. there is a lack of consensus regarding the optimal timing of elective surgery following a SARS-CoV-2. This study aimed to find the optimal time to elective surgery to minimize 30-day postoperative morbidity and mortality.
Methods
This is a retrospective chart review of all adult patients who underwent elective surgery with a confirmed preoperative COVID-19 diagnosis between September 2020 and April 2023. Patients’ elective surgeries delays were examined to determine the optimal time to surgery in terms of postoperative complications. Analysis was controlled for age, ASA score, comorbidities, and smoking status.
Results
358 records examined, 94.7% had delayed surgery and 5.3% had cancelled surgery. The optimal time to surgery was ≥ 17 days to minimize postoperative pulmonary complications [OR: 0.299, p = 0.048], other postoperative complications [OR: 0.459, p = 0.01], and a decrease in length of hospital stay. In multivariate analysis, the only significant predictors for postoperative complications were time to surgery; surgery ≥ 17 days after diagnosis had better postoperative outcomes [p < 0.001], and COVID-19 symptoms status [p = 0.019].
Conclusion
The best time to surgery in this cohort is at least 17 days (or a range of 2–3 weeks) for optimal results. Further research is needed to investigate the effect of such delays on oncological outcomes in this cohort.
... Our findings challenge the historical recommendation of surgical delay after COVID-19. While earlier studies have suggested waiting seven weeks post-infection [31], our data indicate that contemporary COVID-19 may not significantly impact major postoperative outcomes in patients undergoing MBS, potentially reducing unnecessary surgical delays while maintaining safety. ...
Background
The impact of preoperative coronavirus disease (COVID-19) on outcomes after metabolic and bariatric surgery (MBS) remains incompletely understood, as previous studies were conducted early in the pandemic, when viral strains and management differed.
Methods
Using the TriNetX database, we conducted a retrospective analysis of patients who underwent MBS between June 2022 and December 2024. Patients with COVID-19 within 4 weeks before surgery were propensity-score matched 1:1 with controls without prior COVID-19 based on demographics, obesity-associated medical condition, and laboratory values. The primary outcome was the incidence of postoperative pulmonary complications (i.e., pneumonia or acute respiratory failure), while the secondary outcomes included the incidence of acute kidney injury (AKI), intensive care unit (ICU) admission, other infections (i.e., surgical site infection or urinary tract infection), mortality, and emergency department (ED) visits.
Results
Among 34,652 matched patients, 30-day pulmonary complications showed no significant difference between the COVID-19 and control groups (odds ratio[OR]: 0.898, 95%CI:0.674–1.197, p = 0.4646). However, the COVID-19 group experienced higher rates of AKI (OR:1.407, 95%CI:1.087–1.823, p = 0.0093) and ED visits (OR:1.169, 95%CI:1.082–1.264, p < 0.0001). Other secondary outcomes were similar between the groups. COPD, anemia, and old age were significant risk factors for pulmonary complications. Risk factors for AKI include chronic kidney disease, male sex, anemia, diabetes mellitus, and cardiovascular diseases.
Conclusion
Recent preoperative COVID-19 was not associated with increased risk of pulmonary complications following MBS, suggesting surgery need not be delayed for this concern. However, enhanced monitoring of renal complications and post-discharge care may be warranted in patients with identified risk factors.
... 15 Other studies, including the one published by the COVIDSurg collaboration, have suggested that preoperative COVID-19 is associated with an increased risk of postoperative pulmonary or cardiovascular complications and mortality. [22][23][24][25] Interestingly, a more recent study has not observed the same association. 26 While the primary focus of these studies was not specifically on this aspect, it appears that the presence of symptoms at the time of surgery may account for the observed effect of preoperative COVID-19 on postoperative outcomes. ...
Objectives
Our primary objective was to assess the association between symptoms at the time of surgery and postoperative pulmonary complications and mortality in patients with COVID-19. Our secondary objective was to compare postoperative outcomes between patients who had recovered from COVID-19 and asymptomatic patients and explore the effect of the time elapsed between infection and surgery in the former. Our hypotheses were that symptomatic patients had a higher risk of pulmonary complications, whereas patients who had recovered from the infection would exhibit outcomes similar to those of asymptomatic patients.
Background
Managing COVID-19-positive patients requiring surgery is complex due to perceived heightened perioperative risks. However, Canadian data in this context remains scarce.
Design
To address this gap, we conducted a multicentre observational cohort study.
Setting
Across seven hospitals in the province of Québec, the Canadian province was most affected during the initial waves of the pandemic.
Participants
We included adult surgical patients with either active COVID-19 at the time of surgery or those who had recovered from the disease, from March 22, 2020 to April 30, 2021.
Outcomes
We evaluated the association between symptoms or recovery time and postoperative pulmonary complications and hospital mortality using multivariable logistic regression and Cox models. The primary outcome was a composite of any postoperative pulmonary complication (atelectasis, pneumonia, acute respiratory distress syndrome and pneumothorax). Our secondary outcome was hospital mortality, assessed from the date of surgery up to hospital discharge.
Results
We included 105 patients with an active infection (47 were symptomatic and 58 were asymptomatic) at the time of surgery and 206 who had recovered from COVID-19 prior to surgery in seven hospitals. Among patients with an active infection, those who were symptomatic had a higher risk of pulmonary complications (OR 3.19, 95% CI 1.12 to 9.68, p=0.03) and hospital mortality (HR 3.67, 95% CI 1.19 to 11.32, p=0.02). We did not observe any significant effect of the duration of recovery prior to surgery on patients who had recovered from their infection. Their postoperative outcomes were also similar to those observed in asymptomatic patients.
Interpretation
Symptomatic status should be considered in the decision to proceed with surgery in COVID-19-positive patients. Our results may help optimise surgical care in this patient population.
Study registration
ClinicalTrials.gov Identifier: NCT04458337 registration date: 7 July 2020.
... The data collection methodology was validated previously, in terms of case ascertainment and data accuracy 16,17 . The hospital lead had access to the data entered by their team. ...
... There was no formal sample size calculation for the analysis proposed and all eligible patients were included. To ensure global generalizability of the results and to justify the resources put into the study, a minimum number of 300 centres contributing patient-level data from 70 countries was estimated, based on previous cohort studies (that is GlobalSurg and COVIDSurg studies) 16,17 . Assuming an average of 30 patients per centre, a minimum sample size of 10 000 patients was predicted. ...
Technological advancement is important to improve healthcare
quality and safety, especially in surgery1
. For patients with an
inguinal hernia, mesh and minimally invasive surgery are the
two main technologies that have improved healthcare quality
and safety2,3
. The use of mesh is proven to reduce recurrence4,5
.
This avoids the need for further repairs, which are technically
more challenging and have a higher risk for patients6
. The use
of minimally invasive surgery has proven advantages in
bilateral hernias and in female patients2,3 and is recommended
in unilateral repair where appropriate expertise is available2,3
.
Access to these technologies and the expertise required are not
widely or equitably distributed at a global level. As it is the case for
other technologies, countries in the Global South have more
limited access1
. At the same time, in this part of the globe, there
is a higher prevalence and a higher burden of disease associated
with inguinal hernias7
. Several barriers to implementation in
the Global South have been identified previously, including
costs, distribution, and training8,9
. To overcome these, studies
reporting the use of mesh based on mosquito net mesh and
evaluating training programmes have been conducted10,11. With
these efforts and with global investment in new technologies
and the expansion of existing technologies, it was expected that
there would be an increase in their use in low–middle-income
countries. Data assessing this variability have not been collected
in a standardized way and are usually reported from singlecountry or single-region studies5,12. Therefore, identification of
areas where improvement is most needed will be key to better
inform policymakers.
... The data collection methodology was validated previously, in terms of case ascertainment and data accuracy 16,17 . The hospital lead had access to the data entered by their team. ...
... There was no formal sample size calculation for the analysis proposed and all eligible patients were included. To ensure global generalizability of the results and to justify the resources put into the study, a minimum number of 300 centres contributing patient-level data from 70 countries was estimated, based on previous cohort studies (that is GlobalSurg and COVIDSurg studies) 16,17 . Assuming an average of 30 patients per centre, a minimum sample size of 10 000 patients was predicted. ...
... Increased mortality and pulmonary complications were also observed in patients undergoing surgery within 6 weeks of SARS-CoV-2 diagnosis. Therefore, it was indicated that surgery should be delayed for at least 7 weeks after infection, and even longer in those patients with persistent symptoms [5]. ...
The use of lung ultrasound progressively increased during the SARS-CoV-2 pandemic. The presence of a pulmonary interstitial pattern, consolidations, and pleural alterations, with a typically bilateral, predominantly peripheral, and patchy distribution, are common ultrasound findings in COVID-19 pneumonia. In asymptomatic patients recovered from SARS-CoV-2 infection, residual lung lesions were also detected by ultrasound. Ultrasound lung abnormalities have also been found in asymptomatic patients without baseline lung pathology and with some systemic disease. Therefore, although lung ultrasonography has demonstrated comparable sensitivity to other imaging techniques, its specificity is limited, especially compared to CT for the diagnosis of COVID-19. The real impact of the lesions caused by SARS-CoV-2 must be determined by integrating the ultrasound pattern with the clinical context and laboratory results. Lung ultrasound has not only contributed to the early identification of COVID-19 but is also a very useful tool in making decisions about hospital admission and therapeutic strategies.
... Second, it could be used to inform a decision to delay elective surgery until a time when community SARS-CoV-2 infection rates are lower or vaccination (or booster doses) are provided. 8 Third, it would help to stratify the use of resource-intensive interventions to modify risk and improve capacity to rescue patients from complications. 9 Finally, it could inform case prioritisation to address the growing backlog of cancelled elective surgeries worldwide. 10 This study aimed to derive and validate a novel prognostic model to estimate risk of pulmonary complications of elective surgery using data from three large, international, prospective cohort studies. ...
... A full description of methods and findings of this study has been published. 8 This study dataset was selected for model derivation as it was the largest and most data-rich for model fitting, with the broadest inclusion criteria (ie, most generalisable). The protocol of GlobalSurg-CovidSurg Week was prospectively registered at ClinicalTrials.gov ...
... Of note, we did not include patients with recent preoperative SARS-CoV-2 infection in this study and the model is not directly applicable to this group; other data are available to inform clinical decision making here. 8 Although some of the variability in PPC rates might have been due to inclusion of a small number of patients with undetected SARS-CoV-2, much of this variation would be captured by community SARS-CoV-2 transmission rates; preoperative SARS-CoV-2 testing had little effect on model discrimination and was dropped in penalised regression. ...
Background Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery.
... The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for global healthcare systems and had a significant impact on perioperative management. 1 Therefore, understanding the effects of preoperative COVID-19 on postoperative outcomes has become a major concern associated with perioperative care. 2 Early during the pandemic, a multicenter prospective study by the COVIDSurg and GlobalSurg Collaborative highlighted a significant correlation between COVID-19 within 7 weeks before surgery and increased 30-day postoperative mortality. 3 This finding was pivotal to determining the proper timing for elective surgeries. However, because of its reduced virulence and the advent of vaccines, the impact of preoperative COVID-19 on postoperative outcomes has evolved. ...
Background:
We evaluated the impact of preoperative COVID-19 on early postoperative mortality in patients undergoing time-sensitive cancer surgery.
Methods:
This retrospective, nationwide cohort study included adult patients who underwent various cancer (thyroid, breast, stomach, colorectal, hepatobiliary, genitourinary, lung, and multiple cancer) surgeries under general anesthesia in South Korea in 2022. Patients were grouped according to the duration from the date of COVID-19 confirmation to the date of surgery (0–2 weeks, 3–4 weeks, 5–6 weeks, and ≥7 weeks). Patients without preoperative COVID-19 also were included. Multivariable logistic regression analysis with Firth correction was performed to investigate the association between preoperative COVID-19 and 30-day and 90-day postoperative mortality. The covariates encompassed sociodemographic factors, the type of surgery, and vaccination status in addition to the aforementioned groups.
Results:
Of the 99,555 patients analyzed, 30,933 (31.1%) were preoperatively diagnosed with COVID-19. Thirty-day mortality was increased in those who underwent surgery within 0–2 weeks after diagnosis of COVID-19 (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.02–2.12; P = 0.038); beyond 2 weeks, there was no significant increase in mortality. A similar pattern was observed for 90-day mortality. Full vaccination against COVID-19 was associated with reduced 30-day (OR 0.38; 95% CI 0.29–0.50; P < 0.001) and 90-day (OR 0.39; 95% CI 0.33–0.46; P < 0.001) mortality.
Conclusions:
Cancer surgery within 2 weeks of COVID-19 diagnosis was associated with increased early postoperative mortality. These findings support current guidelines that recommend postponing elective surgery for at least 2 weeks after the diagnosis of COVID-19.
... We have previously validated our data collection methodology in terms of case ascertainment and data accuracy. 17,18 Each hospital lead was responsible for data accuracy and data completeness collected and uploaded from their teams. The data were checked centrally and when there were missing data or invalid data, the hospital lead was contacted to complete and correct the data ...
... To ensure global generalisability of the results and to justify the resources put into the study, we estimated a minimum number of 300 hospitals contributing patientlevel data from 70 countries, based on previous cohort studies (ie, GlobalSurg, COVIDSurg). 17,18 Assuming an average of 30 patients per hospital, we predicted a minimum sample size of 10 000 patients. A sample of 10 000 equates to margins of error between 0·2% and 0·85% depending on the binary outcome and a width of 0·39 for the continuous outcome (see appendix 1 p 40 for full details). ...
Background Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia as a tracer condition.
... G lobal surgical and perioperative impacts should be considered as part of the enormous toll exacted by the COVID-19 pandemic. Early reports illustrated a high mortality rate of up to 24% in surgical patients with a perioperative COVID-19 infection, [1][2][3][4][5][6][7] and ongoing research continues to indicate an elevated risk of COVID-19-associated perioperative morbidity and mortality. [8][9][10][11][12] The majority of previous research did not differentiate elective care from urgent surgery. ...
... Previous studies have attempted to define the perioperative mortality of patients infected with COVID-19. [1][2][3]7,9,10,24,25 Many of these studies encompass international surveys and the experience of countries with a different patient demographic than the United States. Most United States studies are limited to isolated surgical populations or do not investigate mortality. ...
... The risks of surgery after COVID-19 infection must be balanced against the risks of delaying surgery; these data will help to guide the shared decision-making and discussions that should occur among the patient, the surgeon, and the anesthesiologist. In contrast to previous work indicating that the risk of mortality is significant up to 7 weeks, 3 we observed that this risk tapered off after 2 weeks. Another study demonstrated that a composite risk of complications and death declined with time after infection. ...
Background
Surgical procedures performed on patients with recent exposure to COVID-19 infection have been associated with increased mortality risk in prior studies. Accordingly, elective surgery is often delayed after infection. We aimed to compare 30-day hospital mortality and postoperative complications (acute kidney injury, pulmonary complications) of surgical patients with a prior COVID-19 infection, to a matched cohort of patients without known prior COVID-19. We hypothesized that COVID-19 exposure would be associated with an increased mortality risk.
Methods
In this retrospective observational cohort study, patients presenting for elective inpatient surgery across a multicenter cohort of academic and community hospitals from April 2020 to April 2021 who had previously tested positive for COVID-19 were compared to controls who had received at least one prior COVID-19 test but without a known prior COVID-19 positive test. We matched cases based on anthropometric data, institution, and comorbidities. Further, we analyzed outcomes stratified by timing of a positive test result in relation to surgery.
Results
30-day mortality occurred in 229/4951 (4.6%) of COVID-19 exposed patients and 122/4951 (2.5%) controls. Acute kidney injury was observed in 172/1814 (9.5%) of exposed patients and 156/1814 (8.6%) controls. Pulmonary complications were observed in 237/1637 (14%) of exposed patients and 164/1637 (10%) controls. COVID-19 exposure was associated with an increased 30-day mortality risk (adjusted odds ratio 1.63, 95% CI 1.38-1.91), an increased risk of pulmonary complications (1.60, 1.36-1.88), but not associated with an increased risk of acute kidney injury (1.03, 0.87-1.22). Surgery within 2 weeks of infection was associated with a significantly increased risk of mortality and pulmonary complications, but that effect was non-significant after 2 weeks.
Conclusion
Patients with a positive test for COVID-19 prior to elective surgery early in the pandemic have an elevated risk of perioperative mortality and pulmonary complications, but not acute kidney injury as compared to matched controls. The span of time from positive test to time of surgery affected the mortality and pulmonary risk, which subsided after 2 weeks.
