No need to wait more than two weeks, new study says

Postponing operations following a positive COVID-19 test may be creating unnecessary delays in elective surgeries, new findings suggest.

In the early days of the pandemic, the American Society of Anesthesiologists recommended delaying nonurgent surgeries by up to seven weeks following SARS-CoV-2 infection. These guidelines were based on research at the time that showed that COVID-19 was associated with an increased risk of post-operative difficulties including pulmonary complications.

Now, in the midst of the latest wave—predominantly driven by subvariants of omicron known as FLiRT and LB.1—many medical institutions continue to take conservative measures even though the newest infections have tended to be milder.

A new study shows that there is no significant benefit in delaying surgeries longer than two weeks after SARS-CoV-2 infection. The researchers published their findings in Annals of Surgery on August 1.

“The same mandate for postponing surgery that was necessary before isn’t supported by the most recent evidence,” says Ira Leeds, MD, assistant professor of surgery at Yale School of Medicine, who was the study’s first author.

Following the onset of the pandemic, elective surgeries came to a screeching halt. “For the first six months to a year of the COVID-19 pandemic, unless there was a true urgency, cases were being routinely delayed based on local policies supported by society guidelines at the time,” says Leeds.

Later on, as these procedures went back on schedule, surgeons grappled with how to provide patients with the beneficial outcomes of surgery while minimizing the risk of COVID-related post-operative complications. Given that both surgery and COVID-19 can place stress on organs such as the heart and lungs, surgeons took great precautions.

“The data at the time suggested that among those who were seriously ill from COVID-19, there were long-term sequelae [condition following prior disease/injury],” says Leeds. For example, these patients faced greater risks associated with mechanical ventilation and blood clots.

However, when later waves of COVID-19 eased in severity, surgeons had little guidance on whether weeks-long delays were still protecting patients, especially those who had mild or asymptomatic infections.

Surgery within two weeks of infection associated with adverse outcomes

In its latest study, Leeds’ team used Veterans Affairs administrative data from April 2020 to September 2022 to identify more than 80,000 patients who had undergone an inpatient surgical procedure. The most common surgeries patients underwent were hernia repairs and knee replacements. Of this cohort, 16,000 had a positive COVID-19 test before surgery.

The researchers divided these patients into groups based on the number of days between the most recent positive test and the date of surgery. Then, they matched patients in the COVID-positive and control groups based on factors including which disease they were being treated for, which procedure they underwent, and which medical center they visited.

The researchers compared mortality within 90 days and post-operative complications within 30 days. Their analysis revealed that there were no significant differences between the groups—with the exception of those who had tested positive within two weeks before their surgery.

These patients were the only ones who had a higher risk of mortality and post-operative complications[BI1] —including cardiopulmonary complications, blood clots, and post-operative infections—compared to the controls.

The study offers evidence that previous guidelines for delaying surgery are no longer beneficial to patients—preventing them from receiving timely care while offering no further protection from COVID-related complications.

“If someone is being hospitalized for COVID a week before their surgery, and they can wait a couple of weeks, then, yes, they should,” says Leeds. “But anything more than two weeks was not associated with better surgical outcomes.”