General and Digestive Surgery Department -, Hospital Clínico Universitario Lozano Blesa, Calle San Juan Bosco, 15, 50009, Saragossa, Spain.
Angiology and Vascular Surgery Department -, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain.
Updates Surg. 2024 Jun;76(3):1091-1097. doi: 10.1007/s13304-024-01800-y. Epub 2024 Mar 15.
During the surge of the SARS-CoV-2 pandemic, studies revealed high complication and morbidity rates following surgical procedures in COVID-19 positive patients. Anesthetic and surgical societies swiftly developed strategies to mitigate these risks, including a recommended postponement of elective surgeries for a minimum of 7 weeks post-COVID infection. Nowadays, with a predominantly vaccinated population, it has become crucial to discern the influencing factors on post-COVID morbidity and mortality and a reevaluation of the existing recommendations pertaining to elective surgery.
A single-center case-control study was conducted, including patients who underwent surgery between November 2021 and March 2022 and met the inclusion criteria. Eighty COVID-19 positive patients were matched 1:1 with 80 controls, each undergoing an identical intervention within a 2-week time frame. The primary outcome was 30-day postoperative mortality and secondary outcome postoperative complications (respiratory and thromboembolic).
At the time of surgery, 88.8% of patients in the case group and 92.5% in the control group had received at least one vaccine dose. Mortality and morbidity did not show a significant difference when comparing the case and control groups (7.5% vs 6.2%, p = 0.755; 11.3% vs 8.9%, p = 0.541 respectively). In the COVID-positive group, mortality was significantly associated with age over 70 years, ASA score over III, RCRI over 1, emergency procedures, and absence of thromboembolic prophylaxis.
In contrast to previously reported findings, we did not observe an increased morbi-mortality in patients with perioperative COVID-19 infection. It may not be necessary to delay elective interventions, except in cases with a high-risk.
在 SARS-CoV-2 大流行期间，研究表明 COVID-19 阳性患者手术后的并发症和发病率较高。麻醉和外科协会迅速制定了策略来降低这些风险，包括建议在 COVID 感染后至少 7 周推迟择期手术。如今，随着接种疫苗人群的增加，区分 COVID 后发病率和死亡率的影响因素以及重新评估与择期手术相关的现有建议变得至关重要。
进行了一项单中心病例对照研究，纳入 2021 年 11 月至 2022 年 3 月期间接受手术且符合纳入标准的患者。80 例 COVID-19 阳性患者与 80 例对照患者 1:1 匹配，每组在 2 周内接受相同的干预措施。主要结局是 30 天术后死亡率，次要结局是术后并发症（呼吸和血栓栓塞）。
在手术时，病例组和对照组分别有 88.8%和 92.5%的患者接受了至少一剂疫苗。比较病例组和对照组，死亡率和发病率没有显著差异（7.5%比 6.2%，p=0.755；11.3%比 8.9%，p=0.541）。在 COVID-19 阳性组中，死亡率与年龄>70 岁、ASA 评分>III、RCRI>1、急诊手术和无血栓栓塞预防显著相关。
与之前报道的结果不同，我们没有观察到围手术期 COVID-19 感染患者的死亡率和发病率增加。除非存在高风险，否则不需要延迟择期干预。
