According to a new global study, surgery should be delayed for seven weeks after a patient tests positive for COVID-19 – as operations taking place up to six weeks after diagnosis are associated with an increased risk of death.

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Researchers discovered that patients are more than two-and-a-half times more likely to die after their operations if the procedure takes places in the six weeks following a positive diagnosis for SARS-CoV-2.

Led by experts at the University of Birmingham, more than 25,000 surgeons worked together as part of the COVIDSurg Collaborative to collect data from 140,727 patients in 1,674 hospitals across 116 countries including India, Australia, Brazil, China, the UAE, UK and the USA - creating one of the world’s largest and broadest studies on surgery; 56 hospitals in India participated in the study, being one of the largest contributors to the study.

What makes this study more significant?

While it is known that infection with SARS-CoV-2 during surgery increases mortality and international guidelines recommend surgery should be delayed for patients testing positive for COVID-19, there is little evidence regarding the optimal duration of the delay. This is one if not the largest surgical cohort studies done in the world, which, for the first time gives us evidence on how the least amount of time delay in doing surgery could optimise final outcomes. This will however need to be balanced by the disease risk to the patient.

Participating hospitals included all patients undergoing a surgical procedure in October 2020. Patients who became infected with SARS-CoV-2 after their surgery were excluded from the study. The primary outcome measure was 30-day postoperative death.

Statistical modelling was used to adjust for patient, disease, and operation variables and calculate adjusted 30-day mortality rates for different time periods from SARS-CoV-2 diagnosis to surgery.

Findings

Time to surgery from SARS-CoV-2 diagnosis was 0 to 2 weeks in 1,144 (0.8%), 3 to 4 weeks in 461 (0.3%), 5 to 6 weeks in 327 (0.2%), 7 weeks or more in 1,205 (0.9%), and 137,590 (97.8%) did not have SARS-CoV-2 infection. Adjusted 30-day mortality in patients who did not have SARS-CoV-2 infection was 1.5%. This was increased in patients operated at 0 to 2 weeks (4.0%), 3 to 4 weeks (4.0%), and at 5 to 6 weeks (3.6%), but not at 7 to 8 weeks (1.5%) after SARS-CoV-2 diagnosis.

These findings were consistent across age groups, differing severity of the patient’s condition, the urgency of surgery, and grade of surgery and sensitivity analyses for elective surgery. Following a delay of seven weeks or more, patients with ongoing COVID-19 symptoms (6.0%) had higher mortality than patients whose symptoms had resolved (2.4%) or who had been asymptomatic (1.3%).

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Monish S Raut is a Consultant in Cardiothoracic Vascular Anaesthesiology. His area of expertise is perioperative management and echocardiography with numerous publications in various national and international indexed journals.