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

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.

Two years of the COVID-19 pandemic: an anesthesiology perspective

“…In a multicenter database study, major surgery in the first four weeks after COVID-19 diagnosis was associated with higher risks of postoperative pulmonary complications and sepsis. [22] These findings are consistent with a prior international study that found an increased 30-day mortality rate after surgery performed within seven weeks of COVID-19 diagnosis. [23] Therefore, the decision to schedule elective surgery should consider the severity of COVID-19, the risks of complications, and the risks of delaying surgery.…”

COVID-19 in the perioperative setting: A review of the literature and the clinical landscape

“…Interval studies continue to demonstrate elevated postoperative risk persisting for at least four weeks from index infection, including mortality, pulmonary complications, or VTE risk. 13 , 14 , 15 , 16 , 17 , 18 , 19 This elevated risk of postoperative complications is also seen with postoperative acquisition of COVID-19 infection. 4 , 6 , 20 , 21 …”

The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis

“…Aerosolized droplets generated when making pneumoperitoneum in minimally-invasive surgeries, such as laparoscopy and robotic surgeries, which have taken up a large part in recent decades, can increase the risk of COVID-19 infection and threaten surgeons and other healthcare workers ( 7 , 8 ). Moreover, several studies have demonstrated that patients with COVID-19 had increased postoperative morbidity, including pulmonary complications, and high mortality ( 9 , 10 ). For these reasons, various guidelines have recommended delaying non-urgent elective surgery and proceeding with conservative treatment for diseases that can be treated conservatively ( 11 ).…”