The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States

To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications. It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative co...

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Published in:	Annals of surgery Vol. 275; no. 2; p. 242
Main Authors:	Deng, John Z, Chan, Janine S, Potter, Alexandra L, Chen, Ya-Wen, Sandhu, Harpal S, Panda, Nikhil, Chang, David C, Yang, Chi-Fu Jeffrey
Format:	Journal Article
Language:	English
Published:	United States 01.02.2022
Subjects:	COVID-19 - diagnosis COVID-19 Testing Elective Surgical Procedures - adverse effects Humans Pneumonia - diagnosis Postoperative Complications - diagnosis Pulmonary Embolism - diagnosis Respiratory Insufficiency - diagnosis Risk Factors SARS-CoV-2 Sepsis - diagnosis Time-to-Treatment United States United States
ISSN:	1528-1140, 1528-1140
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Abstract	To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications. It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications. The risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 ("pre-Covid-19"), (2) 0 to 4 weeks after SARS-CoV-2 infection ("peri-Covid-19"), (3) 4 to 8 weeks after infection ("early post-Covid-19"), and (4) ≥8 weeks after infection ("late post-Covid-19"). Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients. Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.
AbstractList	To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications.OBJECTIVETo assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications.It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications.SUMMARY BACKGROUND DATAIt is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications.The risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 ("pre-Covid-19"), (2) 0 to 4 weeks after SARS-CoV-2 infection ("peri-Covid-19"), (3) 4 to 8 weeks after infection ("early post-Covid-19"), and (4) ≥8 weeks after infection ("late post-Covid-19").METHODSThe risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 ("pre-Covid-19"), (2) 0 to 4 weeks after SARS-CoV-2 infection ("peri-Covid-19"), (3) 4 to 8 weeks after infection ("early post-Covid-19"), and (4) ≥8 weeks after infection ("late post-Covid-19").Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients.RESULTSOf the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients.Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.CONCLUSIONSMajor, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications. To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications. It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications. The risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 ("pre-Covid-19"), (2) 0 to 4 weeks after SARS-CoV-2 infection ("peri-Covid-19"), (3) 4 to 8 weeks after infection ("early post-Covid-19"), and (4) ≥8 weeks after infection ("late post-Covid-19"). Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients. Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.
Author	Chen, Ya-Wen Deng, John Z Sandhu, Harpal S Chang, David C Potter, Alexandra L Chan, Janine S Panda, Nikhil Yang, Chi-Fu Jeffrey
Author_xml	– sequence: 1 givenname: John Z surname: Deng fullname: Deng, John Z organization: David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA – sequence: 2 givenname: Janine S surname: Chan fullname: Chan, Janine S organization: Keck School of Medicine of the University of Southern California, Los Angeles, CA – sequence: 3 givenname: Alexandra L surname: Potter fullname: Potter, Alexandra L organization: University of California, Berkeley, CA – sequence: 4 givenname: Ya-Wen surname: Chen fullname: Chen, Ya-Wen organization: Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA – sequence: 5 givenname: Harpal S surname: Sandhu fullname: Sandhu, Harpal S organization: Department of Bioengineering, University of Louisville, Louisville, KY – sequence: 6 givenname: Nikhil surname: Panda fullname: Panda, Nikhil organization: Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA – sequence: 7 givenname: David C surname: Chang fullname: Chang, David C organization: Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA – sequence: 8 givenname: Chi-Fu Jeffrey surname: Yang fullname: Yang, Chi-Fu Jeffrey organization: Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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SubjectTerms	COVID-19 - diagnosis COVID-19 Testing Elective Surgical Procedures - adverse effects Humans Pneumonia - diagnosis Postoperative Complications - diagnosis Pulmonary Embolism - diagnosis Respiratory Insufficiency - diagnosis Risk Factors SARS-CoV-2 Sepsis - diagnosis Time-to-Treatment United States
Title	The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States
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