The influence of <scp>SARS‐CoV</scp>‐2 vaccination on post‐operative outcomes in microsurgery patients

Taghioff, Susan M.; Slavin, Benjamin R.; Narasimman, Manish; Samaha, Georges; Samaha, Mario; Holton, Tripp; Singh, Devinder P.

doi:10.1002/micr.30940

Cited by 5 publications

(2 citation statements)

References 43 publications

(69 reference statements)

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“…This study also provides evidence that vaccination can reduce the risk of adverse postoperative events in patients with a Hx of COVID-19. This is in line with numerous other studies supporting the prioritization of preoperative vaccination 15,24–26 …”

Section: Discussionsupporting

confidence: 91%

“…This is in line with numerous other studies supporting the prioritization of preoperative vaccination. 15,[24][25][26] The data presented in this study included patients who underwent surgery before March 2023, and thus reflect the environment as the pandemic shifts to an endemic phase. For comparison, the data collected for the COVIDSurg study was in October 2020, and the Deng and colleagues study of patients in the United States included surgeries performed until June 2021.…”

Section: Discussionmentioning

confidence: 99%

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Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery

et al. 2023

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Objective: To determine how severity of prior history of SARS-CoV-2 infection influences postoperative outcomes following major elective inpatient surgery. Summary Background Data: Surgical guidelines instituted early in the COVID-19 pandemic recommended delay in surgery up to 8 weeks following an acute SARS-CoV-2 infection. This was based on the observation of elevated surgical risk following recovery from COVID-19 early in the pandemic. As the pandemic shifts to an endemic phase, it is unclear if this association remains, especially for those recovering from asymptomatic or mildly symptomatic COVID-19. Methods: Utilizing the National Covid Cohort Collaborative (N3C), we assessed postoperative outcomes for adults with and without a history of COVID-19 who underwent major elective inpatient surgery between January 2020 and February 2023. COVID-19 severity and time from infection to surgery were each used as independent variables in multivariable logistic regression models. Results: This study included 387,030 patients, of whom 37,354 (9.7%) were diagnosed with preoperative COVID-19. History of COVID-19 was found to be an independent risk factor for adverse postoperative outcomes even after a 12-week delay for patients with moderate and severe SARS-CoV-2 infection. Patients with mild COVID-19 did not have an increased risk of adverse postoperative outcomes at any time point. Vaccination decreased the odds of respiratory failure. Conclusions: Impact of COVID-19 on postoperative outcomes is dependent on severity of illness, with only moderate and severe disease leading to higher risk of adverse outcomes. Existing perioperative policies should be updated to include consideration of COVID-19 disease severity and vaccination status.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery

et al. 2023

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The influence of SARS‐CoV‐2 vaccination on post‐operative outcomes in microsurgery patients

et al. 2022

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Background The healthcare industry's efforts to immunize the global community against severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) have been unprecedented. Given the fast‐tracking of the novel vaccine, its short‐ and long‐term medical implications remain largely to‐be‐determined in most patient populations. This study aims to analyze 90‐day post‐operative outcomes in microsurgical patients, who have received or not received SARS‐CoV‐2‐vaccination, using a continuously updated federated electronic medical record network (TriNetX Inc, Cambridge, MA). Methods After screening 70 million de‐identified records, 16,799 microsurgery patients aged 18–99 meeting medical coding criteria were allocated into two cohorts. Cohort One received SARS‐CoV‐2‐vaccination prior to undergoing microsurgery whereas Cohort Two did not. Two equally sized cohorts, totaling 818 patients were created after propensity score matching for characteristics including: age, race, ethnicity, smoking, hypertension, heart disease, diabetes, obesity, chronic obstructive pulmonary disease, and history of SARS‐CoV‐2 exposure. Postoperative outcomes within 30‐, 60‐, and 90‐days of microsurgery were analyzed. Results Patients who were SARS‐CoV‐2‐immunized experienced significantly lower ( p < .01) surgical site infections (Absolute Risk Reduction (ARR)[95%CI]) = (3.79%–5.36% [0.84–8.54]) ICU admission (9.47%–9.82%[5.45–13.88]), generalized infections (7.68%–9.92%[3.15–14.64]), and hospitalizations (28.48%–32.57%[20.99–40.13]) within 30‐, 60‐, and 90‐days of microsurgery. Additionally, SARS‐CoV‐2‐vaccinated patients also experienced significantly less flap failure (2.49%[0.97–4.02]) and death (2.46%[0.96–3.97]) within 30‐ and 60‐days post‐operatively. Conclusion Our analysis examines the potential protective effect of SARS‐CoV‐2‐vaccination in microsurgical patients. Limitations include the retrospective nature of this analysis and the inherent reliance on medical coding. Future prospective studies are warranted to better understand if in fact pre‐operative SARS‐CoV‐2‐vaccination has the potential to protect against post‐operative microsurgery outcomes.

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Risk of Early Postoperative Cardiovascular and Cerebrovascular Complication in Patients with Preoperative COVID-19 Undergoing Cancer Surgery

SenthilKumar,

Verhagen,

Nimmer

et al. 2024

Journal of the American College of Surgeons

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Background: As the COVID-19 pandemic shifts to an endemic phase, an increasing proportion of cancer patients with a preoperative history of COVID-19 will require surgery. This study aimed to assess the influence of preoperative COVID-19 on postoperative risk for major adverse cardiovascular and cerebrovascular events (MACE) among those undergoing surgical cancer resection. Secondary objectives included determining optimal time-to-surgery guidelines based on COVID-19 severity and discerning the influence of vaccination status on MACE risk. Study Design: National COVID Cohort Collaborative (N3C) Data Enclave, a large multi-institutional dataset, was used to identify patients that underwent surgical cancer resection between January 2020 and February 2023. Multivariate regression analysis adjusting for demographics, comorbidities, and risk of surgery was performed to evaluate risk for 30-day postoperative MACE. Results: Of 204,371 included patients, 21,313 (10.4%) patients had a history of preoperative COVID-19. History of COVID-19 was associated with an increased risk for postoperative composite MACE as well as 30-day mortality. Among patients with mild disease who did not require hospitalization, MACE risk was elevated for up to 4-weeks following infection. Postoperative MACE risk remained elevated 8+ weeks following infection in those with moderate disease. Vaccination did not reduce risk for postoperative MACE. Conclusion: Together, these data highlight that assessment of the severity of preoperative COVID-19 infection should be a routine component of both preoperative patient screening as well as surgical risk stratification. In addition, strategies beyond vaccination that increase patients’ cardiovascular fitness and prevent COVID-19 infection are needed.

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The influence of SARS‐CoV‐2 vaccination on post‐operative outcomes in microsurgery patients

Cited by 5 publications

References 43 publications

Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery

Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery

The influence of SARS‐CoV‐2 vaccination on post‐operative outcomes in microsurgery patients

Risk of Early Postoperative Cardiovascular and Cerebrovascular Complication in Patients with Preoperative COVID-19 Undergoing Cancer Surgery

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