Identifying Optimal Surgical Timing Relative to SARS-CoV-2 Infection Using COVID-19 Severity in Cancer Patients

ABSTRACT

INTRODUCTION: Prior literature suggests a need to delay elective surgery up to 8 weeks in patients with a previous SARS-CoV-2 infection to mitigate the risk of adverse postoperative events. However, these recommendations are broad without specific consideration of surgical procedures or factors related to the SARS-CoV-2 infection. The objective of this study was to identify optimal surgical timing in cancer patients with a prior history of COVID-19. METHOD(S) This study was a retrospective cross-sectional study using the National COVID Cohort Collaborative (N3C) centralized data resource. Patients who underwent select major surgeries after January 2020 were assessed for 30-day surgical outcomes. Cancer diagnoses, procedures, and outcomes were identified using standard SNOMED concepts. Patients with a history of COVID-19 prior to surgery were grouped by severity non-hospitalized vs. hospitalized. Surgical timing relative to previous COVID-19 diagnosis was separated into three groups 0-4 weeks, 4-8 weeks, and 8+ weeks. All analyses were performed using the N3C Data Enclave. RESULT(S) The study included 133,469 cancer patients with 7,757 (5.8%) who had a history of COVID-19 prior to surgery. Patients with prior COVID-19 did not have significantly increased rates of 30-day mortality (1.1% vs. 0.9%, P=.11) or non-fatal adverse events (23% vs. 22%, P=.33). Of the patients with a history of COVID-19, 1,630 (16%) were hospitalized due to a prior infection. Patients hospitalized for COVID-19 had significantly increased rates of postoperative 30-day mortality (2.9% vs. 0.5%, P< .001) and non-fatal adverse events (38% vs. 20%, P< .001) when compared to patients with a history of non-hospitalized COVID-19. Multivariable regression examining risk for any adverse event in patients with non-hospitalized COVID-19 demonstrated patients to be at baseline risk at 0-4 weeks (aOR 1.02 [0.68-1.50]), 4-8 weeks (aOR 0.98 [0.65-1.43]) and 8+ weeks (aOR 0.97 [0.80-1.17]) when compared to patients without a history of COVID-19. Conversely, patients previously hospitalized for COVID-19 were at increased odds of adverse postoperative events at all assessed time points (Figure). CONCLUSION(S) These data suggest prolonged delays from COVID-19 diagnosis to surgery are unnecessary among cancer patients not hospitalized for SARS-CoV-2 infection. However, there is a persistently elevated postoperative risk in patients who were hospitalized for treatment of COVID-19 prior to undergoing cancer surgery. Additional risk mitigation strategies beyond delaying surgery must be investigated.