Optimal Timing of Elective Surgery after Covid 19 Infection
Abstract
Introduction: Scheduling surgeries and management of surgical emergencies have been revolutionized by the outbreak of the novel coronavirus disease (COVID-19). The aim of this study was to determine the optimum timing of elective surgery for patients after COVID-19 infection in order to operate the deserving patients and avoid future burden on the health care facility and staff.
Material and Methods: A total of 636 patients were included in this prospective cohort study, which was conducted at General Surgical Department, Hayatabad Medical Complex, Peshawar, Khyber Pakhtunkhwa from January to December 2021. The cohort included 162 patients in the per0-COVID-19, 202 patients in the early post COVID-19 and 272 patients in the late post COVID-19 period.
Results: The primary outcome measure was status of post-operative complications and 30-day postoperative mortality in patients stratified over period of post-operative infection. Majority of patients were males (58%) with oncological indicators (16.67%) as the major reasons and Cholecystectomy (17%) was the major surgery. Similarly, diabetes was the major comorbodity (13%) noted in the cohort. The period before surgery significantly affected the outcome and minimum post-operative complications were noted in the late post COVID-19 group. Respiratory system complications, oxygen therapy and pneumonia were significantly more in the peri-COVID-19 group. Consequently, maximum days of hospitalization (7) and 30 days post operative mortality (9.2%) was noted in the peri COVID-19 group.
Conclusion: It is concluded from this study to delay the surgery to more than 7 weeks after COVID-19 infection, where possible.
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Introduction
The first outbreak of the novel coronavirus disease (COVID-19) caused by the SARS Coronavirus 2 (SARS-CoV-2) occurred in Wuhan province, China, in December 2019. The novel virus quickly spread to the other provinces of China as well as rest of the world and on March 11, 2020, the World Health Organization (WHO) announced the new coronavirus disease 2019 (COVID-19) a global pandemic, declaring the outbreak an international emergency. The pandemic caused a major disarray of routine hospital services globally which has led to a reduction in the elective surgeries in better interest of the patients and general public; preserving personal protective equipment; reducing in-hospital viral transmission and preserving ward and ICU facilities for the needed patients along with reducing burden on health care providers (1) . A large number of patients have been already affected by the COVID-19 pandemic and the number is increasing even further day by day. These patients require, either currently or will require elective surgeries in the future. Due to the disease affecting multi-organ system with increased post-operative complications, careful pre-operative evaluation of the patient and optimum timing for elective surgery is required in order to have good post-operative results and improved quality of life. With approximately half of SARS-CoV-2- infected patients undergoing surgery experiencing postoperative pulmonary complications such as pneumonia, respiratory failure, arrhythmias, pulmonary embolism (PE), and deep venous thrombosis (DVT), evidence points to a 19.1% 30-day mortality in elective (planned) surgical patients and a 26.0% 30-day mortality in emergency surgical patients (2, 3).
Conclusion
Late post COVID-19 group were having least post-operative complications as compared to peri- and early post COVID-19 groups. Surgery conducted during or around the time of COVID-19 infection has, thus increased the risk of developing postoperative complications. As a consequence, patients operated during the per-COVID-19 period seemed to have the highest mortality. Based on our findings, we recommend that patients with recent COVID-19 infection who are candidates for elective surgery postpone their surgery for at least 7 weeks.