Preoperative COVID-19 and Postoperative Mortality in Cancer Surgery: A South Korean Nationwide Study

Jae-Woo Ju ^1,2, Soo-Hyuk Yoon ¹, Tak Kyu Oh ^2,3

⁰Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Annals of Surgical Oncology +

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June 15, 2024

View abstract on PubMed

Summary

Postponing cancer surgery for at least two weeks after a COVID-19 diagnosis significantly reduces early postoperative mortality. This finding supports current guidelines for managing patients with cancer and COVID-19.

Area Of Science

Oncology
Infectious Diseases
Public Health

Background

The impact of preoperative COVID-19 on outcomes for patients undergoing cancer surgery is a critical concern.
Understanding the risks associated with the timing of surgery after COVID-19 diagnosis is essential for patient management.

Purpose Of The Study

To evaluate the association between preoperative COVID-19 and early postoperative mortality in patients undergoing time-sensitive cancer surgery.
To determine the optimal waiting period between COVID-19 diagnosis and cancer surgery to minimize mortality risks.

Main Methods

A retrospective, nationwide cohort study of 99,555 adult patients in South Korea who underwent cancer surgery in 2022.
Patients were categorized based on the time from COVID-19 confirmation to surgery (0-6 weeks and ≥7 weeks), with a control group without preoperative COVID-19.
Multivariable logistic regression with Firth correction analyzed the association between preoperative COVID-19 timing and 30-day/90-day postoperative mortality, adjusting for sociodemographic factors, surgery type, and vaccination status.

Main Results

31.1% of patients had preoperative COVID-19. Surgery within 0-2 weeks of COVID-19 diagnosis was linked to increased 30-day mortality (aOR, 1.47; 95% CI, 1.02-2.12).
No significant increase in mortality was observed for surgeries performed beyond 2 weeks post-COVID-19 diagnosis.
Full COVID-19 vaccination was associated with reduced 30-day (aOR, 0.38) and 90-day (aOR, 0.39) mortality.

Conclusions

Cancer surgery within two weeks of COVID-19 diagnosis is associated with higher early postoperative mortality.
These findings reinforce current recommendations to postpone elective surgery for at least two weeks following a COVID-19 diagnosis.
Optimizing surgical timing and vaccination status are crucial for improving outcomes in cancer patients with a history of COVID-19.

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