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择期手术时机和 SARS-CoV-2 感染后的风险评估:2023 年更新:代表麻醉师协会、外科专业协会联合会、英国皇家麻醉学院和皇家外科学院的多学科共识声明。

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: 2023 update: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, Federation of Surgical Specialty Associations, Royal College of Anaesthetists and Royal College of Surgeons of England.

机构信息

Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.

King's College London, London, UK.

出版信息

Anaesthesia. 2023 Sep;78(9):1147-1152. doi: 10.1111/anae.16061. Epub 2023 Jun 19.

Abstract

Guidance for the timing of surgery following SARS-CoV-2 infection needed reassessment given widespread vaccination, less virulent variants, contemporary evidence and a need to increase access to safe surgery. We, therefore, updated previous recommendations to assist policymakers, administrative staff, clinicians and, most importantly, patients. Patients who develop symptoms of SARS-CoV-2 infection within 7 weeks of planned surgery, including on the day of surgery, should be screened for SARS-CoV-2. Elective surgery should not usually be undertaken within 2 weeks of diagnosis of SARS-CoV-2 infection. For patients who have recovered from SARS-CoV-2 infection and who are low risk or having low-risk surgery, most elective surgery can proceed 2 weeks following a SARS-CoV-2 positive test. For patients who are not low risk or having anything other than low-risk surgery between 2 and 7 weeks following infection, an individual risk assessment must be performed. This should consider: patient factors (age; comorbid and functional status); infection factors (severity; ongoing symptoms; vaccination); and surgical factors (clinical priority; risk of disease progression; grade of surgery). This assessment should include the use of an objective and validated risk prediction tool and shared decision-making, taking into account the patient's own attitude to risk. In most circumstances, surgery should proceed unless risk assessment indicates that the risk of proceeding exceeds the risk of delay. There is currently no evidence to support delaying surgery beyond 7 weeks for patients who have fully recovered from or have had mild SARS-CoV-2 infection.

摘要

鉴于广泛的疫苗接种、毒性较弱的变异株、当代证据以及增加安全手术机会的需求,我们需要重新评估 SARS-CoV-2 感染后手术时机的指导原则。因此,我们更新了之前的建议,以协助政策制定者、行政人员、临床医生,以及最重要的是患者。对于计划手术前 7 周内(包括手术当天)出现 SARS-CoV-2 感染症状的患者,应进行 SARS-CoV-2 筛查。通常不应在 SARS-CoV-2 感染诊断后 2 周内进行择期手术。对于已从 SARS-CoV-2 感染中康复且为低风险或接受低风险手术的患者,大多数择期手术可在 SARS-CoV-2 阳性检测后 2 周进行。对于感染后 2 至 7 周内不属于低风险或接受非低风险手术的患者,必须进行个体风险评估。这应考虑:患者因素(年龄;合并症和功能状况);感染因素(严重程度;持续症状;疫苗接种);和手术因素(临床优先级;疾病进展风险;手术级别)。这种评估应包括使用客观和经过验证的风险预测工具以及共同决策,并考虑到患者自身对风险的态度。在大多数情况下,如果风险评估表明继续手术的风险超过延迟手术的风险,则应进行手术。对于已从 SARS-CoV-2 感染中完全康复或仅有轻度 SARS-CoV-2 感染的患者,目前没有证据支持将手术推迟超过 7 周。

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