Short-term perioperative outcomes among patients with concurrent asymptomatic and mild SARS-CoV-2 infection: A retrospective, multicenter study

Abstract

Background Previous studies report high rates of postoperative morbidity and mortality among SARS-CoV-2 (COVID-19) patients. With routine preoperative screening, we are identifying an increasing number of patients with asymptomatic and mild COVID-19. Based on these prior studies, we hypothesized that patients with asymptomatic and mild COVID-19 infections have low perioperative morbidity and mortality. The purpose of this study was to determine the risk of perioperative morbidity and mortality associated with operations performed on patients diagnosed with asymptomatic or mild COVID-19. Methods A multicenter, retrospective study of patients with asymptomatic/mild SARS-CoV-2 (COVID-19) infection diagnosed within 8 days of surgery from March 2020 to February 2021. The primary outcome was 30-day mortality and secondary outcomes included pulmonary complications and perioperative morbidity. The Chinese Center for Disease Control and Prevention criteria of COVID severity was used for categorization. Results The initial cohort included 53 patients. COVID-19 infection was detected preoperatively in 86.8%. At admission, 90.5% of patients were asymptomatic, 7.5% had mild COVID-19 symptoms, and 1.9% were unknown due to obtundation and later determined to be asymptomatic. Of the 53 cases, 35.8% were general surgical and 18.9% orthopedic; the remaining 54.7% were other surgical subspecialties. Overall mortality was 0%. New COVID-19 symptoms developed in 13.2% of patients postoperatively, with only 11.3% developing postoperative pulmonary complications. Conclusion Postoperative morbidity and mortality rates were low among patients with asymptomatic and mild COVID-19. The risks of nonoperative management should be weighed against these operative risks in such patients with surgical indications.

Association of Time to Surgery After COVID-19 Infection With Risk of Postoperative Cardiovascular Morbidity

“…Inclusion of any patient with a positive test result, regardless of timing, makes these results more applicable to the late stage of the pandemic, when most COVID-19 infections have occurred outside of the 7- to 10-day infection window used in most initial perioperative studies. 30 , 31 The requirement for a positive PCR test result allowed for a clear diagnosis as well as time frame; however, patients without a positive PCR test result who did have COVID-19 could have been missed. In addition, the use of a large database and robust informatics infrastructure with rigorous sensitivity analyses allowed for more continuous assessment of risk, rather than arbitrary cutoffs.…”

“…The use of a composite outcome is a unique method to measure risk associated with COVID-19, which is critical when deciding perioperative recommendations. Inclusion of any patient with a positive test result, regardless of timing, makes these results more applicable to the late stage of the pandemic, when most COVID-19 infections have occurred outside of the 7- to 10-day infection window used in most initial perioperative studies . The requirement for a positive PCR test result allowed for a clear diagnosis as well as time frame; however, patients without a positive PCR test result who did have COVID-19 could have been missed.…”

Postoperative Outcomes in Patients Undergoing Orthopedic Surgery Within 90 Days of Coronavirus Disease 2019

“…In a study by Jonker et al, 7 nearly a quarter of patients undergoing elective or emergent surgery during or after recovering from COVID-19 infection encountered a pulmonary complication. Even in asymptomatic or mild COVID-19 infection, Weitzner et al 15 found that 11% of patients had a pulmonary complication in the first 30 days postoperatively. A recent study by Deng et al 8 found an increased risk of pneumonia in patients undergoing major elective surgery 0 to 4 weeks and 4 to 8 weeks after diagnosis of COVID-19, although the overall rate of pneumonia was lower than that reported in other studies at 7% and 3%, respectively.This study also identified a higher risk of pneumonia in joint arthroplasty surgery, LF, UE surgery, and FA surgery; the increased risk of pneumonia in the UE group may be attributed or partially attributed to a higher rate of COPD and emphysema in the patients with preoperative COVID-19 that remained after propensity-score matching.…”

Management of hip fracture in COVID-19 infected patients

“…It has been reported that patients with asymptomatic infection or with only mild symptoms show a lower risk of perioperative morbidity and mortality associated with operations. Therefore, the surgical risk assessment for such patients should be reconsidered from that for patients with symptomatic infection[ 59 ]. However, there are no cohort studies to prove the effect of asymptomatic infection on surgical or prognostic recovery of hip fracture.…”