Surgery should be delayed if patient tests virus positive

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 increased risk of death, according to a new global study.

Researchers discovered that patients are more than two-and-a-half times more likely to die after their operations, if the procedure takes place 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 Australia, Brazil, China, India, the UAE, UK and USA, creating one of the world’s largest and broadest studies on surgery.

Publishing their findings in Anaesthesia, the researchers discovered that patients operated 0-6 weeks after SARS-CoV-2 infection diagnosis were at increased risk of postoperative death, as were patients with ongoing symptoms at the time of surgery.

Co-lead author Dr Dmitri Nepogodiev, from the University of Birmingham, commented: “We recommend that whenever possible surgery should be delayed for at least seven weeks after a positive SARS-CoV-2 test result, or until symptoms resolve if patients have ongoing symptoms for 7 weeks or more after diagnosis.”

Co-lead author Aneel Bhangu, from the University of Birmingham, added: “Decisions regarding delaying surgery should be tailored for each patient, since the possible advantages of a minimum seven-week delay following SARS-CoV-2 diagnosis must be balanced against the potential risks of delay. For some urgent surgeries, for example for advanced tumours, surgeons and patients may decide that the risks of delay are not justified.”

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 delay.

Participating hospitals included all patients undergoing a surgical procedure in October 2020.

WAM