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Recent COVID-19 infection is associated with increased mortality in the ambulatory surgery population
George W Williams1, Talha Mubashir2, Julius Balogh2
1Department of Anesthesiology and Critical Care, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX, United States.
Insights
COVID-19 positive patients face a significantly higher risk of death after ambulatory surgery. This risk is highest when surgery occurs within 45 days of a positive COVID-19 test, suggesting a need for careful timing. Keywords: COVID-19, ambulatory surgery, mortality risk, surgical timing.
Area of Science:
- Medical research
- Surgical outcomes
- Infectious disease epidemiology
Background:
- The impact of COVID-19 on post-operative mortality after ambulatory surgery is not well understood.
- Optimal surgical timing post-COVID-19 diagnosis requires further investigation.
- This study examines the association between prior COVID-19 diagnosis and mortality risk in ambulatory surgery patients.
Purpose of the Study:
- To determine if a history of COVID-19 diagnosis increases the risk of all-cause mortality following ambulatory surgery.
- To analyze the impact of the time interval between COVID-19 diagnosis and surgery on mortality.
- To identify specific surgical procedures associated with different mortality risks in COVID-19 positive patients.
Main Methods:
- Retrospective analysis of 44,976 US adults from the Optum dataset (March 2020-March 2021).
- Patients tested for COVID-19 within 6 months prior to ambulatory surgery were included.
- Primary outcome: all-cause mortality risk stratified by COVID-19 status and Testing to Surgery Interval Mortality (TSIM).
Main Results:
- COVID-19 positive patients had a 2.51-fold increased risk of all-cause mortality compared to COVID-19 negative patients (p < 0.001).
- Elevated mortality risk persisted for COVID-19 positive patients undergoing surgery within 45 days of testing.
- Colonoscopy and plastic/orthopedic surgeries showed lower mortality risks in COVID-19 positive patients (OR=0.21, p=0.01 and OR=0.27, p=0.01, respectively).
Conclusions:
- A positive COVID-19 diagnosis is linked to significantly higher all-cause mortality after ambulatory surgery.
- The greatest mortality risk is observed when ambulatory surgery is performed within 45 days of a positive COVID-19 test.
- Consideration should be given to postponing elective ambulatory surgeries for at least 45 days post-COVID-19 diagnosis, pending further prospective research.
Background:
The effect of COVID-19 infection on post-operative mortality and the optimal timing to perform ambulatory surgery from diagnosis date remains unclear in this population. Our study was to determine whether a history of COVID-19 diagnosis leads to a higher risk of all-cause mortality following ambulatory surgery.
Methods:
This cohort constitutes retrospective data obtained from the Optum dataset containing 44,976 US adults who were tested for COVID-19 up to 6 months before surgery and underwent ambulatory surgery between March 2020 to March 2021. The primary outcome was the risk of all-cause mortality between the COVID-19 positive and negative patients grouped according to the time interval from COVID-19 testing to ambulatory surgery, called the Testing to Surgery Interval Mortality (TSIM) of up to 6 months. Secondary outcome included determining all-cause mortality (TSIM) in time intervals of 0-15 days, 16-30 days, 31-45 days, and 46-180 days in COVID-19 positive and negative patients.
Results:
44,934 patients (4297 COVID-19 positive, 40,637 COVID-19 negative) were included in our analysis. COVID-19 positive patients undergoing ambulatory surgery had higher risk of all-cause mortality compared to COVID-19 negative patients (OR = 2.51, p < 0.001). The increased risk of mortality in COVID-19 positive patients remained high amongst patients who had surgery 0-45 days from date of COVID-19 testing. In addition, COVID-19 positive patients who underwent colonoscopy (OR = 0.21, p = 0.01) and plastic and orthopedic surgery (OR = 0.27, p = 0.01) had lower mortality than those underwent other surgeries.
Conclusions:
A COVID-19 positive diagnosis is associated with significantly higher risk of all-cause mortality following ambulatory surgery. This mortality risk is greatest in patients that undergo ambulatory surgery within 45 days of testing positive for COVID-19. Postponing elective ambulatory surgeries in patients that test positive for COVID-19 infection within 45 days of surgery date should be considered, although prospective studies are needed to assess this.
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