The new study, published in the journal Anesthesia, considered ops conducted in England between March 17, 2018, and March 17 of last year: two years before and after March 17, 2020, when all elective surgery in the UK was temporarily postponed as part of the first Covid lockdown.
The recommended waiting time to undergo surgery after contracting Covid should be reduced from seven weeks to just a fortnight, according to a new study.
Analysis of more than 3.6 million procedures in England suggested it is safe to operate on patients two weeks after a Covid diagnosis – as long as they have recovered.
That would bring down the recommended delay for surgery after a positive test from the current seven weeks.
The study, led by Dr. Alwyn Kotzé, of Leeds University, and Dr. Ciarán McInerney, of Sheffield University, is the first large-scale analysis of NHS operations during the pandemic.
They found that surgical outcomes were “substantially better” than previously thought, even within seven weeks of a positive test.
Previous research showed an increased risk of dying within 30 days or surgery and lung complications up to seven weeks following a positive test in patients who have recovered fully.
But that study, involving more than 140,000 patients from 116 countries, was conducted before vaccines or evidence-based drug therapy for severe Covid became available.
However, UK and German guidance still recommend putting back deferrable elective surgery for seven weeks after a positive Covid test.
The latest guidance in the U.S. recommends seven weeks’ postponement in unvaccinated individuals only.
Given that, all else being equal, delaying surgery usually leads to worse outcomes, the research team wanted to do a fresh analysis to see how safe surgery is following Covid infection in both the era with vaccines and the period of the pandemic before vaccines.
Overall, 30-day postoperative mortality was 0·2 percent and 30-day post-operative complications under one percent in the pandemic-with-vaccine era.
Mortality for surgery conducted within two weeks of a positive test was 1·1 percent, declining to 0·3 percent by four weeks.
Even when the researchers looked at the pre-vaccine pandemic period, results showed lower mortality in England than in the global sample.
The team says it is important to note that, in any six-month window, less than three percent of ops were conducted within the seven-week threshold after a positive PCR test, showing that most UK hospitals were sticking to the seven-week window for no surgery after a positive Covid test.
Dr. Kotzé said: “We conclude that patient outcomes were better for patients receiving care in hospitals in England than the global average.
“While the most recent UK guidelines suggest a risk-based approach to the timing of surgery after SARS-CoV2 infection, clinical experience suggests that, for all but the most urgent elective or emergency surgery, clinicians continue to postpone operations if they are scheduled within seven weeks of SARS-CoV-2 infection.
“If, as our data suggest, the risk associated with surgery after SARS-CoV-2 infection is much lower than previously thought, delaying surgery might cause more harm than good, particularly in patients who have already waited longer than desirable for surgery.”
He added: “This is the first large-scale analysis of surgical outcomes throughout the Covid-19 pandemic timeline.
“It suggests that, in England, surgical patients’ overall risk following an indication of SARS-CoV-2 infection may be lower than previously thought.
“Clinicians followed national guidance by operating on very few patients within seven weeks of a positive Covid test. Across all eras of the pandemic to date, surgical outcomes were substantially better than previously thought, even within seven weeks of a positive test.
“Given that delaying, surgery is likely to worsen patient outcomes in the longer term, we recommend that UK guidelines should reduce the seven-week threshold for low-risk patients who have fully recovered after a positive SARS-CoV-2 test.
“A simple change in emphasis could suffice – for example, suggest that surgery is delayed for no more than two weeks after indication of a SARS-CoV-2 infection unless there are specific circumstances that place an individual at higher risk of poor outcomes.
“This would bring clinical guidance on surgical timing after an indication of SARS-CoV-2 infection into line with common practice regarding other acute respiratory infections.”
Co-author Professor Ramani Moonesinghe, of University College London and National Health Service England (NHSE) National Clinical Director for Critical and Perioperative Care, said: “This analysis provides new and important data on the safety of surgery after Covid infection, and should provide reassurance to patients and clinicians.
“It remains really important to take up the opportunity for vaccination when it is offered, to reduce the risk of severe Covid infection.”
Produced in association with SWNS Talker
