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Association of Time to Surgery After COVID-19 Infection With Risk of Postoperative Cardiovascular Morbidity
John M Bryant1, Christina S Boncyk1, Kimberly F Rengel1
1Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Waiting longer after COVID-19 diagnosis before surgery is linked to fewer major heart complications. This finding aids decisions on optimal surgical timing for patients with prior COVID-19.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Surgical Outcomes
Background:
- The interval between COVID-19 infection and surgery is an understudied risk factor for postoperative complications.
- Understanding this relationship is crucial for optimizing patient care and outcomes.
Purpose of the Study:
- To investigate the association between the time from COVID-19 diagnosis to surgery and the risk of major postoperative cardiovascular morbidity.
- To inform clinical decision-making regarding surgical timing in patients with a history of COVID-19.
Main Methods:
- Retrospective cohort study of 3997 adult patients with a prior COVID-19 diagnosis.
- Data analyzed from a perioperative data warehouse, focusing on the time from diagnosis to surgery.
- Multivariable logistic regression used to assess the primary outcome: a composite of major cardiovascular events within 30 days post-surgery.
Main Results:
- Increased time from COVID-19 diagnosis to surgery was associated with a reduced rate of major postoperative cardiovascular events (aOR, 0.99 per 10 days; P = .006).
- This trend was also observed in vaccinated patients (aOR, 0.98 per 10 days; P = .04).
- The median time from COVID-19 diagnosis to surgery was 98 days.
Conclusions:
- A longer interval between COVID-19 diagnosis and surgery is associated with decreased odds of major postoperative cardiovascular morbidity.
- Findings support informed risk-benefit discussions for optimal surgical timing in patients with a history of COVID-19.
- This research highlights a modifiable factor to improve perioperative outcomes.
Importance:
The time interval between COVID-19 infection and surgery is a potentially modifiable but understudied risk factor for postoperative complications.
Objective:
To examine the association between time to surgery after COVID-19 diagnosis and the risk of a composite of major postoperative cardiovascular morbidity events within 30 days of surgery.
Design, Setting, And Participants:
This single-center, retrospective cohort study was conducted among 3997 adult patients (aged ≥18 years) with a previous diagnosis of COVID-19, as documented by a positive polymerase chain reaction test result, who were undergoing surgery from January 1, 2020, to December 6, 2021. Data were obtained through Structured Query Language access of an existing perioperative data warehouse. Statistical analysis was performed March 29, 2022.
Exposure:
The time interval between COVID-19 diagnosis and surgery.
Main Outcomes And Measures:
The primary outcome was the composite occurrence of major cardiovascular comorbidity, defined as deep vein thrombosis, pulmonary embolism, cerebrovascular accident, myocardial injury, acute kidney injury, and death within 30 days after surgery, using multivariable logistic regression.
Results:
A total of 3997 patients (2223 [55.6%]; median age, 51.3 years [IQR, 35.1-64.4 years]; 667 [16.7%] African American or Black; 2990 [74.8%] White; and 340 [8.5%] other race) were included in the study. The median time from COVID-19 diagnosis to surgery was 98 days (IQR, 30-225 days). Major postoperative adverse cardiovascular events were identified in 485 patients (12.1%). Increased time from COVID-19 diagnosis to surgery was associated with a decreased rate of the composite outcome (adjusted odds ratio, 0.99 [per 10 days]; 95% CI, 0.98-1.00; P = .006). This trend persisted for the 1552 patients who had received at least 1 dose of COVID-19 vaccine (adjusted odds ratio, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .04).
Conclusions And Relevance:
This study suggests that increased time from COVID-19 diagnosis to surgery was associated with a decreased odds of experiencing major postoperative cardiovascular morbidity. This information should be used to better inform risk-benefit discussions concerning optimal surgical timing and perioperative outcomes for patients with a history of COVID-19 infection.
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