Resource: Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study
Source: Anesthesia
Summary: Although it is known that preoperative COVID-19 infection increases mortality, the optimal duration of planned delay before surgery in patients who have had COVID is not clear. This multicenter, prospective study looked at 140,000 patients in 116 countries, of which 2.2% had a preoperative COVID diagnosis. Logistic regression models were used to calculate 30-day mortality rates, stratified by time from the diagnosis of COVID.
Patients operated within 6 weeks of their COVID diagnosis were at an increased risk of 30‐day postoperative mortality and 30‐day postoperative pulmonary complications. These risks decreased to baseline levels in patients who underwent surgery ≥ 7 weeks after COVID diagnosis. These findings were consistent across both low‐risk (age < 70 years, ASA physical status 1–2, minor surgery) and high‐risk (age ≥ 70 years, ASA physical status 3–5, major surgery) sub‐groups.
The authors concluded that surgery should be delayed for at least 7 weeks following COVID infection to reduce the risk of postoperative mortality and pulmonary complications. In addition, patients who are still symptomatic ≥ 7 weeks after COVID infection and undergo surgery also have an increased mortality rate, and may benefit from an even longer delay.
Comment: The 7 week rule applied uniformly to young patients, to ASA I & II, and to minor and elective surgery categories in this analysis, all of which are typical plastic surgery patients. This advice differs from prior recommendations given by the American Society of Anesthesiologists / APSF, which suggested a 4 week delay for mild, non-respiratory symptoms, and 6 weeks for a symptomatic patient who did not require hospitalization.
