Effects of coronavirus severity and vaccination numbers on postsurgical mortality for elective surgical procedures in...

This study investigated whether previous COVID severity and vaccination affected subsequent elective postsurgical mortality and readmission rates at 30, 90 and 365 days.

21 855 veterans were divided into two cohorts, a no-COVID (NC) cohort of 19 338 patients and a previous COVID cohort of 2547 patients. Patients with acute COVID <22 days prior to surgery were excluded. COVID patients were further divided into 1776 Mild and 771 Moderate/Severe. Another comparison cohort was based on vaccinations.

Patients with moderate/severe COVID had higher 30-day (5.9% vs. 3.5%, P = 0.003), 90-day (5.6% vs. 3.41%, P < 0.001), and 365-day mortality (6.07% vs. 3.23%, P < 0.001) than mild COVID or NC patients. They were also more likely to be readmitted (P < 0.001) than mild or NC. Mild COVID increased readmission risk by 16.6% (OR = 1.166). NC patients with no vaccine had higher mortality than vaccinated NC patients (log-rank, P < 0.01). Mortality in NC patients decreased with more time between vaccine dose and surgery (Breslow-Day P < 0.001). The only significant interaction was between mild COVID and time to vaccination predicting death (Breslow-Day P < 0.001).

History of moderate/severe COVID, lack of COVID vaccination, and recency of COVID vaccination may be associated with higher elective surgery mortality and postsurgical readmission rates.