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Postoperative Outcomes in Patients Undergoing Orthopaedic Surgery Within 90 Days of Coronavirus Disease 2019
Andrea H Johnson1, Laura A Stock, Benjamin M Petre
1From Orthopedic Research, Anne Arundel Medical Center, Annapolis, MD (Johnson, Stock, Petre, Keblish, Redziniak, and Gelfand), Spine Surgery, Anne Arundel Medical Center, Annapolis, MD (Patton), the Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, MD (King), and the Orthopedic and Surgical Research, Anne Arundel Medical Center Annapolis, MD, (Turcotte).
Insights
Patients who had recent COVID-19 infection face increased risks for complications, including venous thromboembolism and pneumonia, following elective orthopaedic surgery. Further research is needed to personalize risk assessment for these patients.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has led to widespread infections, with potential long-term systemic effects.
- The impact of recent COVID-19 infection on outcomes following elective orthopaedic surgery remains unclear.
- Understanding these risks is crucial for patient management and surgical planning.
Purpose of the Study:
- To determine if patients undergoing elective orthopaedic surgery after a recent COVID-19 diagnosis experience a higher rate of complications compared to those without a recent diagnosis.
- To identify specific complications and surgical subspecialties associated with increased risk.
Main Methods:
- A retrospective analysis of the TriNetX Research Network database (April 2020-January 2022).
- Inclusion of patients undergoing arthroscopic surgery, total joint arthroplasty, lumbar fusion, upper extremity, and foot and ankle surgery.
- Propensity-score matching was used to compare cohorts with and without recent COVID-19 diagnosis (7-90 days prior to surgery), analyzing 90-day postoperative outcomes including complications, emergency department visits, and readmissions.
Main Results:
- Patients with recent COVID-19 diagnosis showed increased likelihood of venous thromboembolism (VTE) across all surgical subspecialties.
- Increased risk of pneumonia was observed in most surgical cohorts following COVID-19 infection.
- Specific complications varied by subspecialty, including myocardial infarction (arthroscopic surgery, total joint arthroplasty) and infection (lumbar fusion).
Conclusions:
- Elective orthopaedic surgery following COVID-19 infection is associated with a significantly increased risk of complications, particularly VTE and pneumonia.
- The findings highlight the need for careful patient selection and risk stratification.
- Further research is warranted to develop individualized risk assessment strategies for patients with a history of COVID-19.
Introduction:
Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic with several hundred million infections worldwide. COVID-19 causes systemic complications that last beyond the initial infection. It is not known whether patients who undergo elective orthopaedic surgeries after COVID-19 are at increased risk of complications. The purpose of this study was to evaluate whether patients who undergo orthopaedic procedures after recent COVID-19 diagnosis are at increased risk of complications compared with those who have not had a recent COVID-19 diagnosis.
Methods:
The TriNetX Research Network database was queried for patients undergoing elective orthopaedic surgeries from April 2020 to January 2022 in the following subspecialties: arthroscopic surgery, total joint arthroplasty, lumbar fusion, upper extremity surgery, foot and ankle (FA) surgery. Cohorts were defined by patients undergoing surgery with a diagnosis of COVID-19 from 7 to 90 days before surgery and those with no COVID-19 diagnosis 0 to 90 days before surgery. These cohorts were propensity-score matched based on differences in demographics and comorbidities. The matched cohorts were evaluated using measures of association analysis for complications, emergency department (ER) visits, and readmissions occurring 90 days postoperatively.
Results:
Patients undergoing arthroscopic surgery were more likely to experience venous thromboembolism (VTE) ( P = 0.006), myocardial infarction ( P = 0.001), and ER visits ( P = 0.001). Patients undergoing total joint arthroplasty were more likely to experience VTE ( P < 0.001), myocardial infarction ( P < 0.001), pneumonia ( P < 0.001), and ER visits ( P = 0.037). Patients undergoing lumbar fusion were more likely to experience VTE ( P = 0.016), infection ( P < 0.001), pneumonia ( P < 0.001), and readmission ( P = 0.006). Patients undergoing upper extremity surgery were more likely to experience VTE ( P = 0.001) and pneumonia ( P = 0.015). Patients undergoing foot and ankle surgery were more likely to experience VTE ( P < 0.001) and pneumonia ( P < 0.001).
Conclusion:
There is an increased risk of complications in patients undergoing orthopaedic surgery after COVID-19 infection; all cohorts were at increased risk of VTE and most at increased risk of pneumonia. Additional investigation is needed to stratify the risk for individual patients.
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