Since the beginning of the COVID-19 pandemic, healthcare institutions have implemented measures aimed at reducing the risk of nosocomial SARS-CoV-2 transmission, as well as the risk of operating on infected patients. With limited available evidence and the pandemic escalating, many practices were founded on a principle of precaution, which was entirely appropriate [1]. Robust evidence emerged on the scale of nosocomial transmission and the peri-operative risks of undertaking planned surgery in recently infected patients [2, 3]. Although there was a paucity of evidence assessing the balance of risks and benefits associated with pre-operative isolation, it aims to keep systems clean and patients safe.

This month in Anaesthesia, 15,025 authors have collaborated as part of the global COVIDSurg and GlobalSurg initiatives to collect prospective data on 96,454 patients from over 1600 hospitals across 114 countries [4]. Following adjustment for various measured confounders, patients who isolated had a 20% increased risk of postoperative pulmonary complications and this risk increased with longer periods of isolation. The risk climbed to 31% more in those isolating ≥8 days, which is still shorter than recommendations in England for certain patient groups. The question is, can these new data be used to update guidelines and improve clinical practice? First, we must look to the methods used and then dive back into our recent pre-pandemic history when concepts such as prehabilitation and enhanced recovery dominated the peri-operative landscape and promised much for the future.

自 COVID-19 大流行开始以来，医疗机构已实施旨在降低 SARS-CoV-2 院内传播风险以及对受感染患者进行手术的风险的措施。由于可用证据有限且大流行不断升级，许多做法都建立在预防原则的基础上，这是完全合适的 [ 1 ]。出现了关于院内传播规模和对近期感染患者进行计划手术的围手术期风险的有力证据 [ 2, 3 ]。尽管缺乏评估与术前隔离相关的风险和收益平衡的证据，但它旨在保持系统清洁和患者安全。

本月在《麻醉》杂志上，作为全球 COVIDSurg 和 GlobalSurg 计划的一部分，15,025 名作者合作收集了来自 114 个国家/地区的 1600 多家医院的 96,454 名患者的前瞻性数据 [ 4]. 在对各种测量的混杂因素进行调整后，隔离的患者术后肺部并发症的风险增加了 20%，并且这种风险随着隔离时间的延长而增加。在隔离 ≥ 8 天的人群中，风险攀升至 31% 以上，这仍然低于英格兰对某些患者群体的建议。问题是，这些新数据能否用于更新指南和改进临床实践？首先，我们必须研究所使用的方法，然后回顾我们最近的大流行前历史，当时预康复和加速康复等概念在围手术期占主导地位，并为未来带来了很多希望。