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.

FIGURE 2

Surgery timing categories relative to Covid-19 diagnosis date.

FIGURE 1

Flow diagram detailing schema of study subject selection. ^∗Operations included: abdominal aortic aneurysm repair (endovascular approach), abdominal aortic aneurysm repair (open approach), brain tumor resection, carotid endarterectomy, colon surgery, coronary artery bypass grafting, esophagectomy, gastrectomy, mastectomy, hepatectomy, hip replacement, hysterectomy, knee replacement, laminectomy, lung resection (lobectomy, pneumonectomy, and segmentectomy), pancreatic surgery (Whipple, total pancreatectomy, and distal pancreatectomy), prostatectomy, and spinal fusion. ^∗∗Surgery timing categories: “pre-Covid-19”: patients underwent surgery before January 1, 2020 before their Covid-19 diagnosis; “peri-Covid-19”: patients underwent surgery 0 days to 4 weeks after their Covid-19 diagnosis; “early post-Covid-19”: patients underwent surgery 4 to 8 weeks after their Covid-19 diagnosis; “late post-Covid-19”: patients underwent surgery ≥ 8 weeks after their Covid-19 diagnosis.