Association of preoperative coronavirus disease 2019 with mortality, respiratory morbidity and extrapulmonary complications after elective, noncardiac surgery: An observational cohort study

Yi-Heng Liu ¹, Chenghong Hu ², Xia-Min Yang ¹

⁰Department of Anesthesiology, Huashan Hospital of Fudan University, Shanghai, China.

Journal of Clinical Anesthesia +

|

April 9, 2024

View abstract on PubMed

Summary

Preoperative coronavirus disease 2019 (COVID-19) did not increase risks for 30-day mortality, pulmonary complications, myocardial injury, or acute kidney injury after noncardiac surgery. However, recent COVID-19 infection elevated the risk of postoperative delirium.

Area Of Science

Anesthesiology
Infectious Diseases
Surgical Outcomes

Background

The impact of severe acute respiratory coronavirus 2 (SARS-CoV-2) on surgical outcomes remains a critical concern.
Understanding the risks associated with preoperative coronavirus disease 2019 (COVID-19) is essential for patient safety.

Purpose Of The Study

To evaluate the effect of preoperative COVID-19 on 30-day mortality, respiratory morbidity, and extrapulmonary complications following elective noncardiac surgery.
To assess the influence of the timing of surgery relative to COVID-19 diagnosis on postoperative outcomes.

Main Methods

An ambidirectional observational cohort study involving 2907 adult patients undergoing elective noncardiac surgery.
Analysis of primary outcome (30-day mortality) and secondary outcomes including postoperative pulmonary complications (PPCs), myocardial injury after noncardiac surgery (MINS), acute kidney injury (AKI), postoperative delirium (POD), and sleep quality.
Multivariable logistic regression was employed to determine the association between preoperative COVID-19 and adverse outcomes.

Main Results

Preoperative COVID-19 was not significantly associated with increased 30-day postoperative mortality (aOR: 0.40, 95% CI: 0.13-1.28).
No increased risk was observed for PPCs (aOR: 0.99, 95% CI: 0.71-1.38), MINS (aOR: 0.54, 95% CI: 0.22-1.30), or AKI (aOR: 0.34, 95% CI: 0.10-1.09) in patients with preoperative COVID-19.
Surgery within 7 weeks of COVID-19 diagnosis was linked to a higher likelihood of developing postoperative delirium (aOR: 2.26, 95% CI: 1.05-4.86).

Conclusions

Preoperative COVID-19 infection and the timing of surgery do not appear to increase the risk of mortality, PPCs, MINS, or AKI.
Recent COVID-19 infection is associated with an elevated risk of postoperative delirium.
Perioperative brain health assessment is crucial for COVID-19 survivors undergoing surgery.

Keywords:

COVID-19 Postoperative complications Postoperative delirium Postoperative mortality

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