Timing is Everything: Surgical Outcomes for SARS-CoV-2 Positive Patients

BACKGROUND: A debate remains on how long to postpone surgery after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to determine surgical outcomes at different time points after a positive SARS-CoV-2 test. METHODS: This cohort study included non-preoperative critically ill adult surgical patients from 5/2020–5/2021 and a subset of SARS-CoV-2 positive patients 15–30 days before surgery from 5/2020–12/2021. Demographics, comorbidities, surgical variables, and outcomes were compared between SARS-CoV-2 positive patients within 50 days before surgery to SARS-CoV-2 negative surgical patients. Cases were stratified based on the timing of SARS-CoV-2 positivity before surgery in days (< 15, 15–30, > 30). Outcomes were compared between strata and against SARS-CoV-2 negative controls. A multivariable model was built to determine the association that the timing of SARS-CoV-2 positivity has on the odds of a major complication. RESULTS: The SARS-CoV-2 positive cohort had 262 patients compared to 1,840 SARS-CoV-2 negative patients. Timing strata contained 145 (< 15 days), 53 (15–30 days), and 64 (> 30 days). The SARS-CoV-2 positive group had a higher incidence of comorbidities (87.4% vs. 57.2%) and underwent more emergent surgery (45.7% vs. 9.3%). The odds of major complications in patients positive for SARS-CoV-2 before surgery were 1.88 (1.13–3.15) (< 15 days), 0.43 (0.14–1.30) (15–30 days), and 0.98 (0.44–2.21) (31–50 days) times the odds in SARS-CoV-2 negative surgery patients when controlling for other variables. CONCLUSION: Timing of SARS-CoV-2 positivity before surgery has an impact on major complications. In certain cases, it may be appropriate to postpone surgery 14 days after SARS-CoV-2 positivity.