Open AccessTiming is Everything: Surgical Outcomes for SARS‐CoV‐2 Positive Patients
Author(s) -
Codner Jesse A.,
Archer Ryan H.,
Lynde Grant C.,
Sharma Jyotirmay
Publication year - 2023
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-022-06814-4
Subject(s) - medicine , cohort , incidence (geometry) , odds ratio , covid-19 , cardiothoracic surgery , vascular surgery , odds , abdominal surgery , severe acute respiratory syndrome , cardiac surgery , surgery , retrospective cohort study , cohort study , logistic regression , disease , physics , infectious disease (medical specialty) , optics
Background A debate remains on how long to postpone surgery after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We aimed to determine surgical outcomes at different time points after a positive SARS‐CoV‐2 test. Methods This cohort study included non‐preoperative critically ill adult surgical patients from 5/2020–5/2021 and a subset of SARS‐CoV‐2 positive patients 15–30 days before surgery from 5/2020–12/2021. Demographics, comorbidities, surgical variables, and outcomes were compared between SARS‐CoV‐2 positive patients within 50 days before surgery to SARS‐CoV‐2 negative surgical patients. Cases were stratified based on the timing of SARS‐CoV‐2 positivity before surgery in days (< 15, 15–30, > 30). Outcomes were compared between strata and against SARS‐CoV‐2 negative controls. A multivariable model was built to determine the association that the timing of SARS‐CoV‐2 positivity has on the odds of a major complication. Results The SARS‐CoV‐2 positive cohort had 262 patients compared to 1,840 SARS‐CoV‐2 negative patients. Timing strata contained 145 (< 15 days), 53 (15–30 days), and 64 (> 30 days). The SARS‐CoV‐2 positive group had a higher incidence of comorbidities (87.4% vs. 57.2%) and underwent more emergent surgery (45.7% vs. 9.3%). The odds of major complications in patients positive for SARS‐CoV‐2 before surgery were 1.88 (1.13–3.15) (< 15 days), 0.43 (0.14–1.30) (15–30 days), and 0.98 (0.44–2.21) (31–50 days) times the odds in SARS‐CoV‐2 negative surgery patients when controlling for other variables. Conclusion Timing of SARS‐CoV‐2 positivity before surgery has an impact on major complications. In certain cases, it may be appropriate to postpone surgery 14 days after SARS‐CoV‐2 positivity.