Severity of Prior COVID-19 Infection is Associated with Postoperative Outcomes Following Major Inpatient Surgery. medRxiv 2023 Apr 17
Date
05/03/2023Pubmed ID
37131614Pubmed Central ID
PMC10153306DOI
10.1101/2023.04.12.23288412Abstract
OBJECTIVE: To determine the association between severity of prior history of SARS-CoV-2 infection and 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. Given that surgical delay can lead to worse medical outcomes, it is unclear if continuation of such stringent policies is necessary and beneficial for all patients, especially 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 SARS-CoV-2 infection to surgery were each used as independent variables in multivariable logistic regression models.
RESULTS: This study included 387,030 patients, of which 37,354 (9.7%) had a diagnosis of 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 mortality and other complications.
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 wait time policies should be updated to include consideration of COVID-19 disease severity and vaccination status.
Author List
Verhagen NB, SenthilKumar G, Jaraczewski T, Koerber NK, Merrill JR, Flitcroft MA, Szabo A, Banerjee A, Yang X, Taylor BW, Castro CEF, Yen TWF, Clarke CN, Lauer K, Pfeifer KJ, Gould JC, Kothari ANAuthors
Anjishnu Banerjee PhD Associate Professor in the Data Science Institute department at Medical College of WisconsinCallisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Carlos E. Figueroa Castro MD Associate Professor in the Medicine department at Medical College of Wisconsin
Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Jennifer R. Merrill APP Clinical Dir Outpatient in the Surgery department at Medical College of Wisconsin
Kurt J. Pfeifer MD Professor in the Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Data Science Institute department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin