Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2022 Oct;37(10):2106-2113.e1. doi: 10.1016/j.arth.2022.05.006. Epub 2022 May 6.
The Coronavirus Disease 2019 (COVID-19) pandemic has caused a substantial number of patients to have their elective arthroplasty surgeries rescheduled. While it is established that patients with COVID-19 who are undergoing surgery have a significantly higher risk of experiencing postoperative complications and mortality, it is not well-known at what time after testing positive the risk of postoperative complications or mortality returns to normal.
PubMed (MEDLINE), Excerpta Medica dataBASE, and professional society websites were systematically reviewed on March 7, 2022 to identify studies and guidelines on the optimal timeframe to reschedule patients for elective surgery after preoperatively testing positive for COVID-19. Outcomes included postoperative complications such as mortality, pneumonia, acute respiratory distress syndrome, septic shock, and pulmonary embolism.
A total of 14 studies and professional society guidelines met the inclusion criteria for this systematic review. Patients with asymptomatic COVID-19 should be rescheduled 4-8 weeks after testing positive (as long as they do not develop symptoms in the interim), patients with mild/moderate COVID-19 should be rescheduled 6-8 weeks after testing positive (with complete resolution of symptoms), and patients with severe/critical COVID-19 should be rescheduled at a minimum of 12 weeks after hospital discharge (with complete resolution of symptoms).
Given the negative association between preoperative COVID-19 and postoperative complications, patients should have elective arthroplasty surgery rescheduled at differing timeframes based on their symptoms. In addition, a multidisciplinary and patient-centered approach to rescheduling patients is recommended. Further study is needed to examine the impact of novel COVID-19 variants and vaccination on timeframes for rescheduling surgery.
2019 年冠状病毒病（COVID-19）大流行导致大量患者的择期关节置换手术被重新安排。虽然已经确定接受手术的 COVID-19 患者术后发生并发症和死亡的风险显著更高，但术后并发症或死亡率恢复正常的时间尚不清楚。
2022 年 3 月 7 日，系统检索了 PubMed（医学文献在线数据库）、Excerpta Medica dataBASE 和专业学会网站上关于 COVID-19 术前检测阳性患者择期手术最佳重新安排时间的研究和指南，以确定研究和指南。研究结果包括死亡率、肺炎、急性呼吸窘迫综合征、感染性休克和肺栓塞等术后并发症。
共有 14 项研究和专业学会指南符合本系统综述的纳入标准。无症状 COVID-19 患者应在检测阳性后 4-8 周重新安排手术（只要在此期间未出现症状），轻度/中度 COVID-19 患者应在检测阳性后 6-8 周重新安排手术（症状完全缓解），重度/危重症 COVID-19 患者应在出院后至少 12 周重新安排手术（症状完全缓解）。
鉴于术前 COVID-19 与术后并发症之间存在负相关，应根据患者症状将择期关节置换手术重新安排在不同的时间范围内。此外，建议采用多学科和以患者为中心的方法来重新安排患者。需要进一步研究以检查新型 COVID-19 变体和疫苗接种对重新安排手术时间的影响。
