Postoperative mortality risk low by one month after COVID-19, study finds
An analysis of surgeries in England since COVID-19 vaccines were widely available found that surgery within two weeks of a positive SARS-CoV-2 test carried a 1.1% mortality rate, which declined to 0.3% by four weeks after infection.
A large retrospective study found low risk of death or complications among patients having surgery after COVID-19.
The study looked at more than 3 million surgical procedures performed within England's National Health Service from March 17, 2018, to March 17, 2022, to determine whether hospitals adhered to guidance not to operate on patients within seven weeks of SARS-CoV-2 infection and whether postoperative mortality or complications were associated with the interval between COVID-19 infection and subsequent surgery. Results were published March 23 by Anesthesia.
The study found that less than 3% of surgical procedures were conducted within seven weeks of a COVID-19 infection. In the vaccine era, surgical mortality was elevated when a procedure was performed within two weeks of a positive test, at 1.1%, but that rate was substantially lower than the 9.1% reported by the COVIDSurg collaborative in 2021 (based on data gathered before vaccines and evidence-based drug therapy for severe COVID-19 became available). The mortality rate declined to 0.3% by four weeks after infection (compared to 6.9% in COVIDSurg). Overall, the 30-day rates of postoperative mortality and complications in the studied patients were low, at 0.2% and less than 1.0%, respectively.
The results showed that, in accordance with guidelines, “very few patients” underwent surgery within seven weeks of a COVID-19 infection and English patients' postoperative risk after SARS-CoV-2 infection is lower than previous global research had indicated, the study authors said. They noted that many clinicians continue to use the seven-week cutoff.
“If, as our data suggest, the risk associated with surgery after indication of SARS-CoV-2 infection is much lower than previously thought, delaying surgery might cause more harm than good, particularly in patients who have already waited longer than desirable for surgery,” they wrote, calling for U.K. guidelines to be updated. “A simple change in emphasis could suffice, for example, suggest that surgery is delayed for no more than 2 weeks after indication of a SARS-CoV-2 infection unless there are specific circumstances that places an individual at higher risk of poor outcomes.”
The authors cautioned that the findings should not be applied to higher-risk groups, for example, patients with long-lasting COVID-19 symptoms or immunosuppression. The results are also not necessarily generalizable outside England, they said. “We recommend that other countries evaluate their surgical services to assess whether country-specific guidelines were followed, and whether interventions are still appropriate,” the authors wrote.
