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Published on: March 27, 2018
Association Between COVID-19 Infection and Postoperative Outcomes Following Coronary Artery Bypass Grafting: A
Henry Hoang1, Erik Romanelli1, Felix Borngaesser1
1Department of Anesthesiology, Montefiore Medical Center, Bronx, NY.
Insights
Recent COVID-19 infection within two weeks before coronary artery bypass grafting (CABG) surgery significantly increases the risk of serious complications and mortality. Patients require careful consideration due to heightened risks.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has impacted surgical care globally.
- Understanding the risks associated with preoperative infections is crucial for patient safety.
Purpose of the Study:
- To assess the association between the timing of preoperative Coronavirus disease 2019 (COVID-19) infection and postoperative complications in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective cohort study utilized the National COVID Cohort Collaborative (N3C) database.
- Adult patients undergoing CABG were stratified based on COVID-19 infection timing: 0-2 weeks, 2-6 weeks, and 6-12 weeks prior to surgery.
- Outcomes, including venous thromboembolism, sepsis, acute kidney injury, and mortality, were compared between COVID-19-positive and COVID-19-negative groups.
Main Results:
- COVID-19 infection within 0-2 weeks before CABG was linked to significantly higher odds of venous thromboembolism (OR 2.29), sepsis (OR 1.74), 30-day mortality (OR 3.60), and 1-year mortality (OR 3.10).
- No significant associations were found for surgical site infection or acute myocardial infarction in the immediate preoperative period.
- The timing of COVID-19 infection relative to CABG surgery is a critical factor influencing postoperative outcomes.
Conclusions:
- Preoperative COVID-19 infection within two weeks of CABG surgery substantially elevates the risk of major complications and mortality.
- Further investigation into the underlying mechanisms is warranted.
- Optimizing perioperative care strategies for patients with recent COVID-19 infection undergoing CABG is essential.
Objective:
To investigate the association between preoperative Coronavirus disease 2019 (COVID-19) infection and complications in patients undergoing coronary artery bypass grafting (CABG), focusing on the timing of infection.
Design:
A retrospective cohort study using the National Covid Cohort Collaborative (N3C) database SETTING: Multi-institutional data from the National COVID Cohort Collaborative, representing diverse US healthcare settings PARTICIPANTS: Adult patients undergoing CABG during the COVID-19 pandemic, identified through CPT codes. COVID-19 infection timing was stratified into 3 groups: 0 to 2 weeks, 2 to 6 weeks, and 6 to 12 weeks before surgery. Outcomes were analyzed based on the timing of COVID-19 infection and compared to patients without a history of COVID-19.
Interventions:
No direct interventions were performed. Outcomes were analyzed based on the timing of COVID-19 infection.
Measurements And Main Results:
Postoperative complications were assessed using International Classification of Disease, Tenth Revision codes, including venous thromboembolism (VTE), sepsis, acute kidney injury, surgical site infection, acute myocardial infarction (AMI), 30-day mortality, and 1-year mortality. For COVID-19 infection occurring within 0 to 2 weeks before surgery, significantly increased odds were observed for VTE (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.36-3.59]; p = 0.001), sepsis (OR, 1.74; 95% CI, 1.01-2.81; p = 0.032), 30-day mortality (OR, 3.60; 95% CI, 2.32-5.35; p < 0.0001), and 1-year mortality (OR, 3.10; 95% CI, 2.24-4.21; p < 0.0001), with no significant associations for surgical site infection (OR, .94; 95% CI, 0.48-1.64; p = 0.849), or AMI (OR, 1.21; 95% CI, 0.84-1.69; p = 0.274) compared to COVID-19-negative patients.
Conclusions:
COVID-19 infection within 2 weeks before CABG is associated with a significantly increased risk of complications. Further research is needed to understand the mechanisms and optimize care for these patients.
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