The COVID-19 pandemic has caused many patients to delay important medical services. Various screenings, such as mammography and lung cancer screenings have been delayed, along with necessary surgeries. A frequent question we are asked in the office is if a patient can tolerate a particular surgery from the pulmonary standpoint. This question is often difficult to answer, and we can only define the degree of pulmonary impairment and leave the decision for surgery between the surgeon and patient.
When it comes to an opinion about delaying surgery because of a previous COVID-19 infection, the answer has just become easier. A very large study, which included reported outcomes for 140,231 surgical patients from 1,674 hospitals across 16 countries, has given some important guidance. In a single statement, seven weeks appears to be the ideal time to delay surgery, when possible, after someone tests positive for COVID-19.
Mortality rates for surgical patients without a pre-operative COVID-19 diagnosis were 1.4%. The risk of death was about 3.5-4 times higher in the first six weeks after surgery among more than 3,000 patients with a pre-operative diagnosis of COVID-19. Specifically, the rates were as follows: 0-2 weeks = 9.1%; 3-4weeks = 6.9%; 5-6 weeks = 5.5%; and 7 weeks or longer = 2.0%.
These recommendations, of course, do not pertain to surgeries that are considered emergencies. However, it seems reasonable that for surgeries that are elective and, especially if the patient has other disease risk factors, waiting seven weeks after a COVID-19 infection is best.