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

John Z. Deng, BS; Janine S. Chan, BS; Alexandra L. Potter; Ya-Wen Chen, MD; Harpal S. Sandhu, MD, FRCSC; Nikhil Panda, MD, MPH; David C. Chang, PhD, MPH, MBA; Chi-Fu Jeffrey Yang, MD

Disclosures

Annals of Surgery. 2022;275(2):242-246. 

In This Article

Abstract and Introduction

Abstract

Objective: To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications.

Summary Background Data: 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.

Methods: 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").

Results: 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.

Conclusions: 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.

Introduction

As of July 2021, over 20 million people in the United States (U.S.) have recovered from coronavirus disease 2019 (Covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1,2] During active SARS-CoV-2 infection, many of these patients had pneumonia,[3,4] respiratory failure,[3,5] arrhythmias,[6–9] and thrombotic complications such as pulmonary embolism (PE)[10,11] and deep vein thrombosis (DVT).[10–12] Over 60% of patients may continue to have persistent symptoms after these complications.[13–15]

It is unclear whether patients who recovered from Covid-19 can undergo an elective major operation safely. Studies of elective[3,5,9,16] or emergent[3,16] operations on Covid-19 patients during the perioperative period report pulmonary complications ranging from 24.2% to 51.2%,[3,16,17] thromboembolic events from 6.8% to 13.4%,[16,18,19] shock from 11% to 13.9%,[17,19] and 30-day mortality from 9.1% to 32.6%.[3,17–20] However, there are few data on the risks of postoperative complications after surgery following recovery from Covid-19. The objective of this study is to assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative pulmonary complications and other major complications.

processing....