Proposed delay for safe surgery after COVID-19

Joshua G Kovoor^{1

2}, N Ann Scott², David R Tivey^{3

4}, Wendy J Babidge^{3

4}, David A Scott^{5

6}, Vanessa S Beavis⁷, Jen Kok⁸, Andrew D MacCormick^{9

10}, Robert T A Padbury^{11

12}, Thomas J Hugh^{13

14}, Peter J Hewett⁴, Trevor G Collinson¹⁵, Guy J Maddern^{3

4}, Mark Frydenberg^{16

17}

Affiliations

¹ University of Adelaide, Adelaide, South Australia, Australia.
² Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
³ Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
⁴ University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁵ Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.
⁶ Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Anaesthesia and Operating Rooms, Auckland City Hospital, Auckland, New Zealand.
⁸ Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology - Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia.
⁹ Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
¹⁰ Department of Surgery, Counties Manukau District Health Board, Auckland, New Zealand.
¹¹ Flinders University, Adelaide, South Australia, Australia.
¹² Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
¹³ Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Surgical Education, Research and Training Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁵ General Surgeons Australia, Adelaide, South Australia, Australia.
¹⁶ Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia.
¹⁷ Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

PMID: 33656269
PMCID: PMC8014540
DOI: 10.1111/ans.16682

Review

Proposed delay for safe surgery after COVID-19

Joshua G Kovoor et al. ANZ J Surg. 2021 Apr.

. 2021 Apr;91(4):495-506.

doi: 10.1111/ans.16682. Epub 2021 Mar 3.

Authors

Affiliations

¹ University of Adelaide, Adelaide, South Australia, Australia.
² Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
³ Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
⁴ University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁵ Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.
⁶ Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Anaesthesia and Operating Rooms, Auckland City Hospital, Auckland, New Zealand.
⁸ Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology - Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia.
⁹ Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
¹⁰ Department of Surgery, Counties Manukau District Health Board, Auckland, New Zealand.
¹¹ Flinders University, Adelaide, South Australia, Australia.
¹² Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
¹³ Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Surgical Education, Research and Training Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁵ General Surgeons Australia, Adelaide, South Australia, Australia.
¹⁶ Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia.
¹⁷ Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

PMID: 33656269
PMCID: PMC8014540
DOI: 10.1111/ans.16682

Abstract

Background: Long-term effects after COVID-19 may affect surgical safety. This study aimed to evaluate the literature and produce evidence-based guidance regarding the period of delay necessary for adequate recovery of patients following COVID-19 infection before undergoing surgery.

Methods: A rapid review was combined with advice from a working group of 10 clinical experts across Australia and New Zealand. MEDLINE, medRxiv and grey literature were searched to 4 October 2020. The level of evidence was stratified according to the National Health and Medical Research Council evidence hierarchy.

Results: A total of 1020 records were identified, from which 20 studies (12 peer-reviewed) were included. None were randomized trials. The studies comprised one case-control study (level III-2 evidence), one prospective cohort study (level III-2) and 18 case-series studies (level IV). Follow-up periods containing observable clinical characteristics ranged from 3 to 16 weeks. New or excessive fatigue and breathlessness were the most frequently reported symptoms. SARS-CoV-2 may impact the immune system for multiple months after laboratory confirmation of infection. For patients with past COVID-19 undergoing elective curative surgery for cancer, risks of pulmonary complications and mortality may be lowest at 4 weeks or later after a positive swab.

Conclusion: After laboratory confirmation of SARS-CoV-2 infection, minor surgery should be delayed for at least 4 weeks and major surgery for 8-12 weeks, if patient outcome is not compromised. Comprehensive preoperative and ongoing assessment must be carried out to ensure optimal clinical decision-making.

Keywords: COVID-19; SARS-CoV-2; inflammation; long-term; surgery; symptom.

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Conflict of interest statement

None declared.

References

1. Babidge WJ, Tivey DR, Kovoor JG et al. Surgery triage during the COVID‐19 pandemic. ANZ J. Surg. 2020; 90: 1558–65. - PMC - PubMed
1. Doglietto F, Vezzoli M, Gheza F et al. Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID‐19) in Italy. JAMA Surg. 2020; 155: 1–14. - PMC - PubMed
1. COVIDSurg Collaborative . Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS‐CoV‐2 infection: an international cohort study. Lancet 2020; 396: 27–38. - PMC - PubMed
1. Kovoor JG, Tivey DR, Williamson P et al. Screening and testing for COVID‐19 before surgery. ANZ J. Surg. 2020; 90: 1845–56. - PMC - PubMed
1. COVIDSurg Collaborative . Elective surgery cancellations due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans. Br. J. Surg. 2020; 107: 1440–9. - PMC - PubMed

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Proposed delay for safe surgery after COVID-19

Affiliations

Proposed delay for safe surgery after COVID-19

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous