Patients who test positive for COVID-19 should postpone operations to reduce the risk of mortality

A very significant number of international studies indicate that if possible, operations planned for patients who test positive for COVID-19 should be postponed for seven weeks. These patients appear to be two-and-a-half times more likely to die after an operation if the procedure takes place within the first six weeks of having tested positive. Over 140,000 patients in almost 1,700 hospitals worldwide took part in this study, including seventeen hospitals in the Netherlands. Schelto Kruijff and Jean Paul de Vries, surgical oncologist and vascular surgeon/head of the surgical department at the University Medical Center Groningen (UMCG) respectively, are coordinating the Dutch part of the study. The results have been published in the journal Anaesthesia.

It has been known for some time that infection with the coronavirus increases the risk of mortality during operations. International guidelines recommend postponing surgical procedures for patients who test positive for COVID-19 wherever possible. Until now, very little was known about how long these operations should be postponed.

Worldwide study

This worldwide study involved collecting data relating to all patients who underwent a surgical procedure in October 2020. Patients who contracted SARS-CoV-2 after their operation were excluded from the study. The study tried to establish how many of the patients died within 30 days of their operation. These figures were corrected for patient, illness and operation variables, and for the different periods of time between the positive test and the operation.

Mortality percentage

Over 137,500 of the surgical patients in the study were not infected with the coronavirus; 1.5% of this group died within 30 days of the operation. This percentage was higher among patients who were infected with the coronavirus and who underwent an operation after 0-2 weeks (4.0%), 3-4 weeks (4.0%) and 5-6 weeks (3.6%) of having a positive test. Patients with COVID-19, who had a procedure after 7-8 weeks of being tested, had the same mortality percentage (1.5%) as patients who had not been infected with the coronavirus. These results apply to all age categories, irrespective of the patient’s condition and the urgency and nature of the surgical operation.

Make decisions at the patient level

According to Schelto Kruijff, wherever possible, it is advisable to postpone an operation until at least seven weeks after a patient has tested positive for SARS-CoV-2. He also wants individual decisions to be made at the patient level. ‘Decisions regarding postponing an operation must be made separately, with each individual patient. The benefits of postponing for at least seven weeks must be weighed up against the potential risks of postponing. It is possible that surgeons and patients may decide that the risks of postponing certain urgent operations, such as operations on advanced tumours, cannot be justified.’

Over 140,000 patients took part

This international study was headed by researchers from the University of Birmingham. Over 15,000 surgeons from 1,672 hospital in 116 countries worked together to analyse data from a total of over 140,000 patients. It is one the largest global studies ever to be carried out in the field of surgery.

Read the full article in Anaesthesia.