Background: 

Studies indicate that coronavirus disease 2019 (COVID-19) infection before or soon after operations increases mortality, but they do not comment on the appropriate timing for interventions after diagnosis.

Objective: 

We sought to determine what the safest time would be for COVID-19 diagnosed patients to undergo major operative interventions.

Methods: 

High-risk operations, between January 2020 and May 2021, were identified from the Veterans Affairs COVID-19 Shared Data Resource. Current Procedural Terminology (CPT) codes were used to exact match COVID-19 positive cases (n=938) to negative controls (n=7235). Time effects were calculated as a continuous variable and then grouped into 2-week intervals. The primary outcome was 90-day, all-cause postoperative mortality.

Results: 

Ninety-day mortality in cases and controls was similar when the operation was performed within 9 weeks or longer after a positive test; but significantly higher in cases versus controls when the operation was performed within 7 to 8 weeks (12.3% vs 4.9%), 5 to 6 weeks (10.3% vs 3.3%), 3 to 4 weeks (19.6% vs 6.7%), and 1 to 2 weeks (24.7% vs 7.4%) from diagnosis. Among patients who underwent surgery within 8 weeks from diagnosis, 90-day mortality was 16.6% for cases versus 5.8% for the controls (P<0.001). In this cohort, we assessed interaction between case status and any symptom (P=0.93), and case status and either respiratory symptoms or fever (P=0.29), neither of which were significant statistically.

Conclusions: 

Patients undergoing major operations within 8 weeks after a positive test have substantially higher postoperative 90-day mortality than CPT-matched controls without a COVID-19 diagnosis, regardless of presenting symptoms.

中文翻译：

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在 COVID-19 检测呈阳性后进行重大手术干预的时机会影响术后死亡率：来自全国范围内的程序匹配分析的结果

背景： 

研究表明，手术前或手术后不久感染 2019 年冠状病毒病 (COVID-19) 会增加死亡率，但他们没有评论诊断后干预的适当时机。

客观的： 

我们试图确定 COVID-19 确诊患者接受主要手术干预的最安全时间。

方法： 

从退伍军人事务部 COVID-19 共享数据资源中确定了 2020 年 1 月至 2021 年 5 月期间的高风险操作。当前的程序术语 (CPT) 代码用于将 COVID-19 阳性病例 (n=938) 与阴性对照 (n=7235) 精确匹配。时间效应被计算为一个连续变量，然后分组为 2 周的时间间隔。主要结局是 90 天全因术后死亡率。

结果： 

在检测呈阳性后 9 周或更长时间内进行手术时，病例和对照组的 90 天死亡率相似；但在 7 至 8 周（12.3% 对 4.9%）、5 至 6 周（10.3% 对 3.3%）、3 至 4 周（19.6% 对 6.7%）和诊断后 1 至 2 周（24.7% 对 7.4%）。在诊断后 8 周内接受手术的患者中，病例 90 天死亡率为 16.6%，对照组为 5.8%（P <0.001）。在这个队列中，我们评估了病例状态与任何症状（P = 0.93）以及病例状态与呼吸道症状或发烧（P = 0.29）之间的相互作用，两者均无统计学意义。

结论： 

在检测呈阳性后 8 周内接受大手术的患者术后 90 天死亡率显着高于没有 COVID-19 诊断的 CPT 匹配对照组，无论出现症状如何。