PDF(Pubmed)
Abstract：
BACKGROUND: The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient\'s surgical process.
METHODS: The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent.
RESULTS: Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect.
CONCLUSIONS: A balanced preoperative multidisciplinary risk-benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery.
METHODS: The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent.
RESULTS: Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect.
CONCLUSIONS: A balanced preoperative multidisciplinary risk-benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery.
摘要：
背景：既往有SARS-CoV-2感染的患者的适当手术时机和围手术期处理是悬而未决的问题。本文件的目的是支持有关先前感染Sars-CoV-2的患者接受择期手术的临床决策过程。这份文件的接受者是医生，护士,医护人员,和其他专业人员参与患者的手术过程。
方法：意大利麻醉镇痛复苏和重症监护协会（SIAARTI）选择了11位专家，就成人和儿科人群这一主题的关键方面达成共识。该过程文件的方法符合科学文献快速审查和改进的德尔菲法的原则。专家们以翔实的文字形式发表了声明和支持理由。对发言的总体清单进行了表决，以表达同意程度。
结果：患者在感染后7周内不应进行择期手术，除非存在疾病负面演变的风险。为了降低术后死亡的风险，除了使用经过验证的算法来估计围手术期发病率和死亡率的风险外,多学科方法似乎也很有用;应增加与SARS-CoV-2感染相关的风险.在决定进行手术时，还应考虑阳性患者的潜在医院感染风险。大部分证据来自以前的SARS-CoV-2变种,所以证据应该被认为是间接的。
结论：对于先前感染SARS-CoV-2的患者，进行择期手术，需要进行平衡的术前多学科风险效益评估。
方法：意大利麻醉镇痛复苏和重症监护协会（SIAARTI）选择了11位专家，就成人和儿科人群这一主题的关键方面达成共识。该过程文件的方法符合科学文献快速审查和改进的德尔菲法的原则。专家们以翔实的文字形式发表了声明和支持理由。对发言的总体清单进行了表决，以表达同意程度。
结果：患者在感染后7周内不应进行择期手术，除非存在疾病负面演变的风险。为了降低术后死亡的风险，除了使用经过验证的算法来估计围手术期发病率和死亡率的风险外,多学科方法似乎也很有用;应增加与SARS-CoV-2感染相关的风险.在决定进行手术时，还应考虑阳性患者的潜在医院感染风险。大部分证据来自以前的SARS-CoV-2变种,所以证据应该被认为是间接的。
结论：对于先前感染SARS-CoV-2的患者，进行择期手术，需要进行平衡的术前多学科风险效益评估。
