Elective surgery safe after wait time for patients with cancer who had COVID-19
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A wait time of at least 20 days to undergo elective, low-risk, cancer-related surgery appeared safe following recovery from mild to moderate COVID-19, according to study results published in Annals of Surgical Oncology.
Additionally, researchers found that patients with COVID-19 infection requiring inpatient treatment had increased risk for adverse events after surgery, and additional wait time may be required in those with more severe infections.
“As the pandemic progressed, we increasingly found ourselves taking care of [patients with cancer] who previously recovered from SARS-CoV-2 infection and required time-sensitive surgery,” Anai N. Kothari, MD, MS, assistant professor of surgical oncology in the department of surgery at Medical College of Wisconsin, told Healio. “We, and many others, observed some individuals recovering from COVID-19 had persistent symptoms and physiologic impacts — many of which also were known risk factors for adverse events after surgery. Therefore, we found it crucial to understand how having a prior SARS-CoV-2 infection impacted surgical outcomes and, importantly, determine if a wait period of 20 days was sufficient to mitigate these potential risks.”
Methodology
The analysis included 5,682 patients with cancer who underwent elective surgery at The University of Texas MD Anderson Cancer Center between April 6, 2020, and Oct. 31, 2020.
Researchers matched 112 patients (mean age, 51.7; standard deviation, 15.8 years; 64.3% women; 61.6% white) who had a prior COVID-19 infection with 112 patients in a control cohort (mean age, 54.3; standard deviation, 17.1; 61.6% women; 61.6% white) based on patient, disease and surgical factors.
A composite of postoperative events within 30 days of surgery — including death, unplanned readmission, pneumonia, cardiac injury or thromboembolic events — served as the study’s primary outcome.
Key findings
Results showed an average time from COVID-19 infection to surgery of 52 days (range, 20-202). Kothari and colleagues found no difference in the rate of adverse postoperative outcomes in patients with a prior COVID-19 infection compared with matched controls (14.3% vs. 13.4%).
Additionally, patients admitted for inpatient SARS-CoV-2 treatment before surgery demonstrated increased odds of postoperative complications (adjusted OR = 7.4; 95% CI, 1.6-34.3).
“We compared several very specific postoperative parameters, including average oxygen saturation, supplemental oxygen use and intraoperative oxygen demand. Even across these highly specific factors — many we expected to be impacted by prior a SARS-CoV-2 infection — our study groups had no differences,” Kothari said.
Implications
The pandemic’s ongoing impact on cancer care delivery, including the relationships between prior COVID-19 infection and surgical risk, remains an “extremely important” area that warrants continuing research, Kothari told Healio.
“This includes studying surgical risk in those who had more severe infections or develop ‘long-COVID.’ In addition, we are developing predictive tools and strategies to improve outcomes in those who had COVID-19 infection prior to surgery,” he said.
For more information:
Anai N. Kothari, MD, MS, can be reached at Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; email: akothari@mcw.edu.
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