Against the backdrop of widespread COVID-19 vaccination and the emergence of the Omicron variant, our study delved into the correlation between short- and long-term recovery quality and the timing of surgery in patients undergoing general anaesthesia post-SARS-CoV-2 infection. We conducted a six-month follow-up with patients diagnosed with mild or asymptomatic SARS-CoV-2 infection. Notably, the group with an infection duration of less than two weeks displayed diminished QoR-15 scores three days postoperatively and an extended hospital stay. Our findings suggest that scheduling elective general anaesthesia surgery more than two weeks after the diagnosis of mild or asymptomatic SARS-CoV-2 infection may be more favourable for enhancing postoperative recovery quality.
The QoR-15 scale, introduced in 2013 for assessing overall anaesthesia and postoperative recovery quality [18], provides a comprehensive and more efficient evaluation compared to the QoR-40 scale. It is presently endorsed as a standard measurement for clinical trial outcomes [19]. With a total score of 150, higher scores signify superior postoperative recovery quality, and scores of 118 or above are indicative of a good recovery[20]. Our study indicates that the majority of patients, 80% on day 3, and 99% at 3 and 6 months postoperatively, achieved QoR-15 scores of 118 or above, indicating good postoperative recovery quality. However, the group with an infection duration of less than two weeks exhibited significantly lower QoR-15 scores three days postoperatively, consistent with prior research [21, 22]. This may be attributed to inconsistent waiting times post-SARS-CoV-2 infection and anaesthetic agents known to suppress the body's immune function, potentially prolonging active viral replication in patients with compromised immunity, thus slowing recovery from SARA-CoV-2 [23]. Research indicates that patients infected with the Omicron variant within eight weeks before surgery experience a shorter postoperative hospital stay and a significantly reduced risk of adverse postoperative outcomes [24–26]. This aligns with our findings, where the group with an infection duration of less than two weeks exhibited a significantly longer median hospital stay, aligning with the results of QoR-15 scores three days postoperatively. The consistency between these findings underscores the reliability of trial results, emphasizing that undergoing surgery shortly after SARS-CoV-2 infection is not conducive to enhancing recovery quality. SARS-CoV-2 infection may be associated with short- and long-term multi-system sequelae, including chronic pulmonary dysfunction, cognitive impairment, psychological distress, chronic fatigue, etc. [1–5]. Our study identified one patient in Group A who died due to respiratory failure combined with hepatic and renal failure, one readmitted for sepsis, and four reporting fatigue with slight exertion. In Group B, three patients reported slight fatigue with movement, while in Group C, one patient died due to cancer spread, two reported fatigue with slight exertion. In Group D, two patients reported slight fatigue with movement, consistent with previous reports. However, comparisons among the groups revealed no statistically significant differences (P > 0.05). Our study has not observed a significant impact of Omicron variant infection on postoperative survival rates, contrary to previous research indicating an increased risk of postoperative mortality following SARS-CoV-2 infection. Possible reasons include: first, our study focused on patients with mild or asymptomatic infection; second, the low pathogenicity of the Omicron variant itself [27–31]; third, widespread vaccination in China; fourth, previous studies were conducted before the Omicron variant became the dominant strain [32]. Investigating the postoperative short- and long-term sequelae of SARS-CoV-2 infection in Omicron variant-infected individuals with expanded inclusion remains clinically significant. Previous studies primarily explored postoperative mortality and pulmonary complication rates in SARS-CoV-2-infected patients, often conducted before the emergence of the Omicron variant and widespread vaccination, making some findings less applicable to the current scenario. The Omicron variant primarily affects the upper respiratory tract, with most infected individuals exhibiting normal chest CT scans [27–31, 33], resulting in a significant reduction in mortality and pulmonary complications 30 days postoperatively. Therefore, exploring postoperative recovery quality holds greater clinical significance. Additionally, our extended follow-up duration and the use of telephone follow-ups contribute to a lower loss to follow-up rate, enhancing the robustness of the trial.
This study has several limitations. Firstly, being a single-center study, the sample size is limited, and the surveyed population is regionally constrained. Larger-scale prospective studies are required for validation. Secondly, some patients with a history of SARS-CoV-2 infection might have been misclassified as never infected. This is particularly plausible for asymptomatic patients who might not have undergone nucleic acid testing and, consequently, were not included in this study. Additionally, our study did not include an uninfected group, lacking a blank control. Furthermore, we did not conduct stratified discussions or multifactorial regression analysis, neglecting an exploration of factors influencing short- and long-term postoperative recovery quality. Lastly, this study is based on the time from SARS-CoV-2 diagnosis to the day of surgery, but delays in diagnosis might have occurred in some patients, potentially underestimating the true interval between infection and surgery.
In summary, this article examines the prognosis of elective general anaesthesia surgery at different timings in patients with mild or asymptomatic SARS-CoV-2 infection. Despite the relatively low pathogenicity of the Omicron variant, immunosuppression is prevalent in surgical patients. The group with an infection duration of fewer than two weeks undergoing non-emergency general anaesthesia surgery showed a decreased short-term postoperative recovery quality, prolonged hospital stay, and increased risk of postoperative complications, without affecting long-term postoperative recovery quality and postoperative mortality. Therefore, we recommend that patients with mild or asymptomatic SARS-CoV-2 infection wait for more than two weeks before undergoing non-emergency general anaesthesia surgery, as it proves to be a more advantageous choice.