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News2021-03-11

COVID positive patients should delay surgery to reduce death risk

Surgery should be delayed for seven weeks after a patient tests positive for COVID-19 – as

operations taking place up to six weeks after diagnosis are associated with increased risk of

death, according to a new global study.

Researchers discovered that patients are more than two-and-a-half times more likely to die

after their operations, if the procedure takes places in the six weeks following a positive

diagnosis for SARS-CoV-2.

Led by experts at the University of Birmingham, more than 25,000 surgeons worked

together as part of the COVIDSurg Collaborative to collect data from 140,727 patients in

1,674 hospitals across 116 countries including Australia, Brazil, China, India, the UAE, UK and

USA - creating one of the world’s largest and broadest studies on surgery.

Publishing their findings in Anaesthesia, the researchers discovered that patients operated

0-6 weeks after SARS-CoV-2 infection diagnosis were at increased risk of postoperative

death, as were patients with ongoing symptoms at the time of surgery.

Co-lead author Dr Dmitri Nepogodiev, from the University of Birmingham, commented: “We

recommend that whenever possible surgery should be delayed for at least seven weeks after

a positive SARS-CoV-2 test result, or until symptoms resolve if patients have ongoing

symptoms for 7 weeks or more after diagnosis.”

Co-lead author Mr Aneel Bhangu, from the University of Birmingham, added: “Decisions

regarding delaying surgery should be tailored for each patient, since the possible advantages

of a minimum seven-week delay following SARS-CoV-2 diagnosis must be balanced against

the potential risks of delay. For some urgent surgeries, for example for advanced tumours,

surgeons and patients may decide that the risks of delay are not justified.”

While it is known that infection with SARS-CoV-2 during surgery increases mortality and

international guidelines recommend surgery should be delayed for patients testing positive

for COVID-19, there is little evidence regarding the optimal duration of delay.

Participating hospitals included all patients undergoing a surgical procedure in October

2020. Patients who became infected with SARS-CoV-2 after their surgery were excluded

from the study. The primary outcome measure was 30-day postoperative death.

Statistical modelling was used to adjust for patient, disease, and operation variables and

calculate adjusted 30-day mortality rates for different time periods from SARS-CoV-2

diagnosis to surgery.


Time to surgery from SARS-CoV-2 diagnosis was 0-2 weeks in 1,144 (0.8%), 3-4 weeks in 461

(0.3%), 5-6 weeks in 327 (0.2%), 7 weeks or more in 1,205 (0.9%), and 137,590 (97.8%) did

not have SARS-CoV-2 infection. Adjusted 30-day mortality in patients who did not have

SARS-CoV-2 infection was 1.5%. This was increased in patients operated at 0-2 weeks

(4.0%), 3-4 weeks (4.0%), and at 5-6 weeks (3.6%), but not at 7-8 weeks (1.5%) after SARS-

CoV-2 diagnosis.

These findings were consistent across age groups, differing severity of the patient’s

condition, urgency of surgery, and grade of surgery and in sensitivity analyses for elective

surgery. Following a delay of seven weeks or more, patients with ongoing COVID-19

symptoms (6.0%) had higher mortality than patients whose symptoms had resolved (2.4%)

or who had been asymptomatic (1.3%).

Drs Sattar Alshryda (Al Jalila Children’s Specialty Hospital) and Hayder Al Saadi (Rashid

Hospital), the UAE leads for the study explained that thirteen centres and over 40

researchers took part in the study and have contributed over 1000 participants. The

supports that we had received from the Dubai Healthcare City (DHCC) , Ministry of Health,

Dubai health authority , The Department of Health-Abu Dhabi and Sharjah were great. This

collaboration has laid the ground to the birth of a new network of orthopaedic researchers,

provisionally named (U-TORCH) which stands for United Arab Emirates Trauma and

Orthopaedic Research Champions. The purpose is to foster a nationwide, high quality

research across the country.

List of participating countries

Country

Participating hospitals

Country

Participating hospitals

Country

Participating hospitals

Albania

3

Hong Kong

4

Qatar

3

Algeria

3

Hungary

6

Rep. North Macedonia

4

Argentina

9

India

56

Romania

18

Aruba

1

Indonesia

10

Russian Federation 

23

Australia

44

Iran 

16

Rwanda

6

Austria

27

Iraq

7

Saudi Arabia

26

Azerbaijan

2

Ireland

17

Senegal

1

Bahrain

4

Israel

3

Serbia

15

Bangladesh

3

Italy

115

Singapore

4

Barbados

1

Japan

47

Slovakia

2

Belarus

2

Jordan

17

Slovenia

2

Belgium

8

Kazakhstan

5

Somalia

1

Benin

5

Kenya

4

South Africa

9

Bosnia & Herzegovina

2

Korea (Republic)

1

South Sudan

1

Brazil

38

Kuwait

7

Spain

97

Bulgaria

5

Latvia

3

Sri Lanka

11

Cameroon

1

Lebanon

9

Sudan

17

Canada

17

Libya

35

Sweden

9

Chile

9

Lithuania

5

Switzerland

9

China

5

Luxembourg

1

Syrian Arab Republic

14

Colombia

22

Madagascar

6

Taiwan 

1

Congo 

2

Malaysia

10

Thailand

2

Croatia

8

Malta

1

Trinidad and Tobago

1

Cuba

1

Mexico

26

Tunisia

3

Cyprus

3

Moldova 

2

Turkey

47

Czechia

6

Mongolia

1

Uganda

11

Denmark

3

Morocco

7

Ukraine

4

Dominican Rep.

2

Namibia

5

UAE

13

Ecuador

1

Nepal

1

UK

205

Egypt

33

Netherlands

17

USA

69

El Salvador

1

New Zealand

11

Uruguay

2

Estonia

1

Nigeria

31

Yemen

5

Ethiopia

24

Oman

2

Zambia

1

Finland

2

Pakistan

30

Zimbabwe

5

France

44

Palestine

6



Gabon

2

Panama

1



Georgia

1

Paraguay

11



Germany

54

Peru

15



Ghana

8

Philippines 

10



Greece

30

Poland

4



Guatemala

9

Portugal

23




List of participating UAE centres and researchers


Centres

Researchers

1-

Al Jalila Children Speciality Hospital, Dubai

  1. Sattar Alshryda

  2. Ibrar Majid

  3. MA Serour

  4. Abid Qazi

  5. Awadelkarim Mohamed

  6. Hisham Mahmoud Ibrahim Elsayed

  7. Safeena Kherani

  8. Sabina Khan

  9. Vikram S Basappanavar

  10. Rubina Lone Ghulam Ahmed

  11. Suresh kailasam sivamurthy

2-

Rashid hospital, Dubai

  1. Hayder Al Saadi

  2. Bilal EI Yafawi

  3. Hamda Khansaheb

  4. Maitha Alqemzi

  5. Khalid Alawadi


3-

Latifa Women and Children Hospital, Dubai

  1. Diary Abdulrahman

  2. Sheela Anne George Very

  3. Muna AbdulRazzaq Tahlak

4-

Dubai Hospital, Dubai

  1. Ferial Mohamed Ali Abbas 

  2. Maryam Salma Babar

5-

Neuospinal Hospital, Dubai

  1. Antony Louis Rex Michael

  2. Hassan Al Mahdy

6-

Medcare Orthopaedic and Spine, Dubai

  1. Ehab Aldlyami

  2. Amar Alomar

7-

Mediclinic City Hospital, Dubai

  1. Mohamed Ahmed Mashhour

  2. Taiceer Abdulwahab

  3. Murad AbdELnabi

8-

Mediclinic Wellcare Hospital, Dubai

  1. Mohamed Ahmed Mashhour

  2. Amr El Yamany

9-

Mediclinic Parkview Hospital, Dubai


  1. Rakesh Kundra

  2. Mohamed Ahmed Mashhour

10-

Burjeel Hospital, Dubai. 

  1. Mohamed Ahmed Mashhour

  2. Nayzak Raoof

  3. Gavin Spence

11-

Mediclinic Alnour Hospital, Abu Dhabi


  1. Khaled ElSisy

  2. Ahmed Ibrahim

12-

Sheikh Shakhbout Medical City, Abu Dhabi

  1. Amin El Helw

  2. Ravi Trehan

13-

Al Qassimi Hospital, Sharjah

  1. Kareem S. Khalil 

  2. Sameh S Alsafty

  3. Amna Salam

  4. Shaimaa Hamza

  5. Hayder Al-Masari

  6. Omar Sameer

Al Jalila Children's Specialty Hospital

Al Jaddaf - Dubai United Arab Emirates

800 AJCH (8002524)

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