Timing of surgery following SARS-CoV-2 infection
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It is now clear that the lingering effects of COVID-19 can affect health in many ways—including how our body reacts to surgery. A growing number of studies have shown a substantially increased risk of postoperative death and pulmonary complications for at least six weeks after symptomatic and asymptomatic COVID-19 infection.

The findings of the connection between COVID-19 infection and surgical complications and mortality add new variables to the equation, and hospitals and health systems around the country are adopting new policies to keep patients as safe as possible.

Several small studies, including one published in The Lancet, have suggested patients with positive COVID-19 test results may experience worse outcomes and an increased chance of dying after surgery. A large international study, published in Anaesthesia, showed that keeping surgery on hold for at least seven weeks after a positive coronavirus test was associated with lower mortality risk compared with no delay.

The most recent study on this topic was published in JAMA Network Open in April and compared 5,470 surgical patients with positive COVID-19 test results (within six weeks) to 5,470 patients with negative results. There were more than double the number of deaths reported in the COVID-19-positive group versus the group with negative results.

A new policy at Yale-New Haven Health now stipulates that elective surgeries for adult patients that require general or neuroaxial anesthesia should be deferred seven weeks from the time of a known COVID-19 diagnosis.

Additionally, elective surgeries for adults who are immuno-compromised, diabetic, or have a history of hospitalization should be deferred eight to 10 weeks after diagnosis. Those with a history of intensive care hospitalization should be deferred 12 weeks.

Surgeons are advised to discuss the risks of proceeding with surgery with a patient ahead of time.

Source: https://doi.org/10.1111/anae.15458
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