Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.
Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.
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DOI：
10.1111/anae.15458
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发表时间：
2021-06
期刊：
影响因子：
10.7
通讯作者：
GlobalSurg Collaborative
中科院分区：
文献类型：
--
作者：
COVIDSurg Collaborative;GlobalSurg Collaborative
围手术期SARS - CoV - 2感染增加术后死亡率。本研究的目的是确定SARS - CoV - 2感染患者手术前计划延迟的最佳时间。这项国际、多中心、前瞻性队列研究纳入了2020年10月接受选择性或紧急手术的患者。将术前感染SARS - CoV - 2的手术患者与术前未感染SARS - CoV - 2的手术患者进行比较。主要结局指标为术后30天死亡率。使用Logistic回归模型计算从SARS - CoV - 2感染诊断到手术时间分层的调整后30天死亡率。在来自116个国家的140231例患者中，3127例（2.2%）患者术前诊断为SARS - CoV - 2。未感染SARS - CoV - 2的患者调整后30天死亡率为1.5% （95%CI 1.4-1.5）。在术前诊断为SARS - CoV - 2的患者中，在诊断后0-2周、3-4周和5-6周内进行手术的患者死亡率增加（优势比（95%CI）分别为4.1（3.3-4.8）、3.9（2.6-5.1）和3.6(2.0-5.2)）。在SARS‐CoV‐2诊断后≥7周进行手术与基线相似的死亡风险相关（优势比（95%CI） 1.5(0.9-2.1)）。在SARS - CoV - 2感染后手术延迟≥7周后，持续症状患者的死亡率高于症状缓解或无症状患者(分别为6.0% （95%CI 3.2-8.7）、2.4% （95%CI 1.4-3.4）和1.3% （95%CI 0.6-2.0）。在可能的情况下，在SARS - CoV - 2感染后，手术应延迟至少7周。诊断后症状持续≥7周的患者可能受益于进一步的延迟。
Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
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影响因子：
3.8
作者：
Jonker PKC;van der Plas WY;Steinkamp PJ;Poelstra R;Emous M;van der Meij W;Thunnissen F;Bierman WFW;Struys MMRF;de Reuver PR;de Vries JPM;Kruijff S;Dutch Surgical COVID-19 Research Collaborative
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影响因子：
8.8
作者：
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Sanchis, Joaquin
影响因子：
45.3
作者：
Glasbey, James C.;Nepogodiev, Dmitri;Testa, V
通讯作者：
Testa, V
影响因子：
9.6
作者：
Nepogodiev, D.;Omar, Omar M.;Poelaert, Jan
通讯作者：
Poelaert, Jan
影响因子：
3.6
作者：
Canet, Jaume;Sabate, Sergi;Ulke, Zerrin Sungur
通讯作者：
Ulke, Zerrin Sungur