Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery. Ann Surg 2023 Nov 01;278(5):e949-e956
Date
07/21/2023Pubmed ID
37476995Pubmed Central ID
PMC10659141DOI
10.1097/SLA.0000000000006035Scopus ID
2-s2.0-85173563272 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
OBJECTIVE: To determine how the severity of prior history (Hx) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection influences postoperative outcomes after major elective inpatient surgery.
BACKGROUND: Surgical guidelines instituted early in the coronavirus disease 2019 (COVID-19) pandemic recommended a delay in surgery of up to 8 weeks after an acute SARS-CoV-2 infection. This was based on the observation of elevated surgical risk after recovery from COVID-19 early in the pandemic. As the pandemic shifts to an endemic phase, it is unclear whether this association remains, especially for those recovering from asymptomatic or mildly symptomatic COVID-19.
METHODS: Utilizing the National COVID Cohort Collaborative, we assessed postoperative outcomes for adults with and without a Hx 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. Hx 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 the severity of illness, with only moderate and severe disease leading to a higher risk of adverse outcomes. Existing perioperative 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, Figueroa Castro CE, Yen TWF, Clarke CN, Lauer K, Pfeifer KJ, Gould JC, Kothari AN, N3C ConsortiumAuthors
Anjishnu Banerjee PhD Associate Professor in the Institute for Health and Equity 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 Assistant 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
Kathryn K. Lauer MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Jennifer R. Merrill APP 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 Institute for Health and Equity department at Medical College of Wisconsin
Bradley W. Taylor Chief Research Informatics Officer in the Clinical and Translational Science Institute department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultElective Surgical Procedures
Humans
Inpatients
Risk Factors
