COVID-19

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

Deng, John Z. BS∗; Chan, Janine S. BS†; Potter, Alexandra L.‡; Chen, Ya-Wen MD§; Sandhu, Harpal S. MD, FRCSC||,¶; Panda, Nikhil MD, MPH§; Chang, David C. PhD, MPH, MBA§; Yang, Chi-Fu Jeffrey MD#

Author Information

∗David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA

†Keck School of Medicine of the University of Southern California, Los Angeles, CA

‡University of California, Berkeley, CA

§Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA

||Retina Northwest, Portland, OR

Department of Bioengineering, University of Louisville, Louisville, KY

#Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

[email protected].

The data, technology, and services used in the generation of these research findings were generously supplied pro bono by the Covid-19 Research Database partners, who are acknowledged at https://covid19researchdatabase.org/.

David C. Chang and Chi-Fu Jeffrey Yang are co-senior authors.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

Annals of Surgery 275(2):p 242-246, February 2022. | DOI: 10.1097/SLA.0000000000005308

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.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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