Abstract：
Background: Active and recent coronavirus disease 2019 (COVID-19) infections are associated with morbidity and mortality after surgery in adults. Current recommendations suggest delaying elective surgery in survivors for four to 12 weeks, depending on initial illness severity. Recently, the predominant causes of COVID-19 are the highly transmissible/less virulent Omicron variant/subvariants. Moreover, increased survivability of primary infections has engendered the long-COVID syndrome, with protean manifestations that may persist for months. Considering the more than 600,000,000 COVID-19 survivors, surgeons will likely be consulted by recovered patients seeking elective operations. Knowledge gaps of the aftermath of Omicron infections raise questions whether extant guidance for timing of surgery still applies to adults or should apply to the pediatric population. Methods: Scoping review of relevant English-language literature. Results: Most supporting data derive from early in the pandemic when the Alpha variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) predominated. The Omicron variant/subvariants generally cause milder infections with less organ dysfunction; many infections are asymptomatic, especially in children. Data are scant with respect to adult surgical outcomes after Omicron infection, and especially so for pediatric surgical outcomes at any stage of the pandemic. Conclusions: Numerous knowledge gaps persist with respect to the disease, the recovered pre-operative patient, the nature of the proposed procedure, and supporting data. For example, should the waiting period for all but urgent elective surgery be extended beyond 12 weeks, e.g., after serious/critical illness, or for patients with long-COVID and organ dysfunction? Conversely, can the waiting periods for asymptomatic patients or vaccinated patients be shortened? How shall children be risk-stratified, considering the distinctiveness of pediatric COVID-19 and the paucity of data? Forthcoming guidelines will hopefully answer these questions but may require ongoing modifications based on additional new data and the epidemiology of emerging strains.
摘要：
背景：2019年活动性和近期冠状病毒病（COVID-19）感染与成人手术后的发病率和死亡率有关。目前的建议建议将幸存者的择期手术推迟4到12周，取决于最初的疾病严重程度。最近,COVID-19的主要原因是高度传播性/毒性较低的Omicron变体/亚变体。此外，原发感染的生存能力增加导致了长COVID综合征，可能会持续数月的变形金刚表现。考虑到超过6亿的COVID-19幸存者，寻求择期手术的康复患者可能会咨询外科医生。Omicron感染后果的知识差距引发了一个问题，即现有的手术时机指南是否仍然适用于成年人或是否应适用于儿科人群。方法：对相关英语文献进行范围回顾。结果：大多数支持数据来自大流行早期，当时严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）的Alpha变体占主导地位。Omicron变体/亚变体通常引起较温和的感染，器官功能障碍较少；许多感染是无症状的，尤其是儿童。关于Omicron感染后成人手术结果的数据很少，尤其是在大流行的任何阶段的儿科手术结果。结论：关于这种疾病，许多知识差距仍然存在，手术前康复的病人,拟议程序的性质，和支持数据。例如,除紧急择期手术外，所有手术的等待期是否应延长到12周以上，例如，严重/危重疾病后，或长期患有COVID和器官功能障碍的患者？相反，是否可以缩短无症状患者或接种疫苗患者的等待时间？如何对儿童进行风险分层，考虑到儿科COVID-19的独特性和数据的匮乏?即将出台的指南有望回答这些问题,但可能需要根据其他新数据和新出现菌株的流行病学进行持续修改.
