Timing of a Major Operative Intervention After a Positive COVID-19 Test Affects Postoperative Mortality

Abstract

Background: Studies indicate that coronavirus disease 2019 (COVID-19) infection before or soon after operations increases mortality, but they do not comment on the appropriate timing for interventions after diagnosis. Objective: We sought to determine what the safest time would be for COVID-19 diagnosed patients to undergo major operative interventions.Methods: High-risk operations, between January 2020 and May 2021, were identified from the Veterans Affairs COVID-19 Shared Data Resource. Current Procedural Terminology (CPT) codes were used to exact match COVID-19 positive cases (n = 938) to negative controls (n = 7235). Time effects were calculated as a continuous variable and then grouped into 2-week intervals. The primary outcome was 90-day, all-cause postoperative mortality. Results: Ninety-day mortality in cases and controls was similar when the operation was performed within 9 weeks or longer after a positive test; but significantly higher in cases versus controls when the operation was performed within 7 to 8 weeks (12.3% vs 4.9%), 5 to 6 weeks (10.3% vs 3.3%), 3 to 4 weeks (19.6% vs 6.7%), and 1 to 2 weeks (24.7% vs 7.4%) from diagnosis. Among patients who underwent surgery within 8 weeks from diagnosis, 90-day mortality was 16.6% for cases versus 5.8% for the controls (P < 0.001). In this cohort, we assessed interaction between case status and any symptom (P = 0.93), and case status and either respiratory symptoms or fever (P = 0.29), neither of which were significant statistically. Conclusions: Patients undergoing major operations within 8 weeks after a positive test have substantially higher postoperative 90-day mortality than CPT-matched controls without a COVID-19 diagnosis, regardless of presenting symptoms.

Update on Covid-19: vaccines, timing of transplant after COVID-19 infection and use of positive donors

“…This large international prospective study showed that risk did not reach baseline until 7 weeks after COVID-19 diagnosis if symptoms resolved [60]. Another cohort study also showed similar findings with 90-day mortality of 16.6% among patients who underwent surgery within 8 weeks from diagnosis versus 5.8% for the controls ( P < 0.001) [61]. In light of these findings, the American Society of Anesthesiologists and Anesthesia Patient Safety Foundation last recommended in February 2022 that for unvaccinated patient, we delay all elective surgeries for 7 weeks and until they are asymptomatic [62].…”

Estimated Risk of Adverse Surgical Outcomes Among Patients With Recent COVID-19 Infection Using Target Trial Emulation Methods

“…These findings suggest that recent COVID-19 infection was not associated with risk of adverse postoperative outcomes, regardless of timing within the previous 60 days. A recent study found surgery within 8 weeks after a positive COVID-19 test result was associated with higher 90-day mortality vs matched controls . Another study found lower perioperative risk for vaccinated patients and for unvaccinated patients not given general anesthesia .…”

“…A recent study found surgery within 8 weeks after a positive COVID-19 test result was associated with higher 90-day mortality vs matched controls. 3 Another study found lower perioperative risk for vaccinated patients and for unvaccinated patients not given general anesthesia. 4 These studies may shift the timing of surgery relative to recent infection.…”

“…mortality vs matched controls. 3 Another study found lower perioperative risk for vaccinated patients and for unvaccinated patients not given general anesthesia. 4 These studies may shift the timing of surgery relative to recent infection.…”

To Wait or Not to Wait?

“…A recent Veterans Affairs (VA) study found worse postoperative 90-day mortality when surgery was performed within 8 weeks following COVID-19 infection 5. There were, however, several major limitations such as not being able to account for vaccine status and including both elective and emergent cases in their study population.…”