Preoperative SARS-CoV-2 and postoperative outcomes

BackgroundSurgical decision making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity, and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by heterogenous guidance. We aimed to evaluate surgical provision during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary.MethodsUsing the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We evaluated whether hospitals within the English NHS adhered to guidance not to operate on patients with seven weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30-day, 6-month), and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most-recent indication of SARS-CoV-2 infection and subsequent surgery.FindingsIn any 6-month window, less than 3% of surgical procedures were conducted within seven weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within two weeks of a positive test in the pandemic-with-vaccine era was 1·1%, declining to 0·3% by four weeks. Compared to the COVIDSurg study cohort, outcomes for patient in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic-no-vaccine era.InterpretationClinicians within the English NHS followed national guidance by operating on very few patients within seven weeks of a positive indication of SARS-CoV-2 infection. Surgical patients’ overall risk following an indication of SARS-CoV-2 infection was and is lower than previously thought.FundingSalaries were funded by National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre. Data assets were funded by UK Research and Innovation. The OpenSAFELY Platform is supported by grants from the Wellcome Trust, Medical Research Council, NIHR, and Health Data Research UK.