Article Notes
Surgery should be delayed for at least 7 weeks after COVID, although those with persistent COVID symptoms will still have more than twice the 30-day mortality than those without. (COVID Surg Collaborative 2021)
After recovery from SARS-CoV-2 infection, minor surgery should be delayed 4 weeks and major surgery delayed 8-12 weeks. (Kovoor 2021)
Elective surgery should not be scheduled within 7 weeks of a SARS-CoV-2 infection. (El-Boghdadly 2021)
- Female patients treated by male surgeons more commonly experience post-operative complications and death than when treated by female surgeons. (Wallis 2021)
- Care from male surgeons and/or anaesthesiologists is associated with longer lengths of stay after cardiac surgery. (Sun 2021)
- Female heart-attack patients are less likely to survive when treated by a male physician than a female physician. (Greenwood 2018)
- Treatment from female surgeons is associated with a lower 30 day mortality than the same from male surgeons. (Wallis 2017)
- In-patient care from a female physician is associated with lower 30 day mortality and readmission rate among elderly patients. (Tsugawa 2017)
In 2020 the COVID Surg Collaborative demonstrated a shockingly-increased post-operative mortality among patients undergoing surgery during an active COVID infection.
This naturally led to questions regarding timing of elective surgery after COVID-19 recovery.
Although data is scant, the COVID Surg Collaborative again leads the way with a large multicenter study showing increased 30 day mortality even when surgery is delayed 5-6 weeks after COVID infection.
Various guidelines and recommendations exist, but summarising:
Several studies note that these periods are minimum recommended delays, and that patients with persisting symptoms still experience higher 30-day mortality even after delaying seven weeks. El-Boghdadly et al. suggests that this period should be used for functional prehabilitation for these patients.
Daniel Jolley
Patients have increased postoperative risk when surgery occurs in the weeks after COVID recovery.
Daniel Jolley
"...I encourage all patient safety stakeholders to resist an overemphasis on absolute safety, and instead draw on the strengths of both the safety I and safety II approaches. We should be clear about what types of harms can or cannot be prevented and anticipated, work to eliminate those where there is good evidence for preventability by adopting evidence-based practices, improve the ability of everyone responsible for safety to identify risks, conduct better risk analyses to anticipate and reduce unintended harms, measure and celebrate the routine adaptations that prevent harm, and reward organisational learning and improvement." – Thomas, 2020.
Daniel Jolley
File under correlation-is-not-causation-but...
Sometimes even correlations are too significant and important to just be fobbed off by epidemiological cliché. This collection contains articles repeatedly showing association between doctor characteristics, particularly gender, and patient outcome.
Although most recently shown by Wallis in JAMA Surgery (2021), gender-outcome associations are depressingly not new.
The cause of this gender outcome disparity is unclear, and importantly these studies are hypothesis forming, rather than proving. Nonetheless both Wallis (2021) and Greenwood (2018) hint at causes, namely a lack of experience treating female patients for some male doctors, and consequential lesser understanding of gender-disease differences.
The temptation when attempting to understand this is to descend into medical gender essentialism – ironically, probably a contributor to the actual outcome disparities.
A similar doctor-outcome disparity is seen with age. Among physicians, care from older doctors was associated with worse outcomes (Tsugawa 2017), yet for surgeons older age conferred better outcomes (Tsugawa 2018; Satkunasivam 2020). Causes here are possibly a nexus between experience, up-to-date knowledge and work volume – but also, still unclear.
Daniel Jolley