Prior Diagnosis of COVID Has No Increased Complications in Total Joint Arthroplasty

Abstract

IntroductionAlthough a substantial portion of the United States population has been infected with and recovered from Coronavirus , many patients may have persistent symptoms and complications from disease-driven respiratory disease, arrhythmias, and venous thromboembolism (VTE). With institutions resuming elective total joint arthroplasties (TJA), it is unclear whether a prior resolved diagnosis of COVID has any implications on postoperative outcomes. MethodsAll elective TJA performed in 2021 at our institution were retrospectively reviewed and a history of prior COVID+ result recorded. Baseline demographics, days from prior COVID+ result to surgery date, preoperative methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, and laboratory markers were obtained to determine baseline characteristics. Postoperative estimated blood loss (EBL), length of stay (LOS), rate of revision surgery, and discharge destination were compared between groups. Perioperative and postoperative rates of VTE, urinary tract infection (UTI), pneumonia, postoperative oxygen supplementation, cardiac arrhythmia, renal disease, sepsis, and periprosthetic joint infections within six months of surgery were recorded. ResultsOf the 155 elective TJA performed in 2021, 24 patients had a prior COVID+ diagnosis with a mean of 253 days from positive result to surgery date. There were no significant differences in baseline demographics, comorbidities, and preoperative lab markers between groups. Surgeries on patients with a prior COVID+ had a significantly higher EBL (260 vs 175cc), but postoperative outcomes of VTE, UTI, pneumonia, oxygen supplementation requirement, nares MRSA+, cardiac disease, and infection rates between groups were similar. Bivariate logistic regression revealed increased days from COVID+ diagnosis (>6 months) to surgery date were associated with a shorter LOS. ConclusionAlthough a prior COVID+ diagnosis had increased intraoperative blood loss, there were no significant differences in respiratory, infectious, cardiac, and thromboembolic complications up to six months after elective TJA. This study suggests that asymptomatic C+ patients receiving elective TJA do not require more aggressive prophylactic anticoagulation or antibiotic regimens to prevent VTE or perioperative infections. As institutions around the nation resume pre-COVID rates of arthroplasty surgeries, a prior diagnosis of COVID appears to have no effects on postoperative complications.

Patients with Omicron variant infection can safely undergo elective orthopedic surgery: a retrospective cohort study

“…A study [2] from USA in 2022 draw a conclusion that COVID-19 infection history does not appear to increase the risk of VTE following primary TJA. Another study [33] from USA in 2022 represents that a prior diagnosis of COVID appears to have no effects on postoperative complications. These studies are consistent to our conclusion, and modern perioperative treatment focus on enhanced recovery after surgery, as well as prophylactic chemical and appropriate rehabilitation training con rm our con dence to mitigate the negative effect COVID-19 infection may have.…”

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery

“…While there appears to be consensus on increased risk of perioperative complications in trauma surgery in COVID-19-positive patients, 16 , 27 , 44 , 45 our results with regard to joint arthroplasty are in contrast to some recent reports arguing COVID-19 positivity does not significantly increase risk of respiratory, infectious, cardiac, and thromboembolic complications. 46 , 47 These differences may again be explained by the quality and size of studied databases and retrospective nature of analyses.…”

Complications thrombotiques postopératoires à la suite d’une intervention chirurgicale majeure chez des patient·es ayant des antécédents de COVID-19 : une analyse de cohorte rétrospective des bénéficiaires assuré·es commercialement aux États-Unis

“…This finding has been replicated across several retrospective single- and multicentre studies in the USA, which failed to show a significant difference in rates of postoperative VTE among elective surgical populations based on COVID-19 history. 34 – 36 These observational studies convey some degree of ambiguity, however, as related sequelae are indeed associated with COVID-19 history, including postoperative pneumonia and greater length of hospital stay. 34 , 36 A substudy analysis of an international prospective cohort study found significantly increased rates of postoperative VTE among patients undergoing surgery with active or recent infections (within one to six weeks of diagnosis), contrary to comparable rates of VTE reported observationally among postoperative patients stratified by COVID-19 history as described elsewhere in the literature.…”