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Coronavirus disease 2019-related risk factors for postoperative delirium: a secondary analysis of an observational
Yi-Heng Liu1, Chenghong Hu2, Xia-Min Yang1
1Department of Anesthesiology, Huashan Hospital of Fudan University, Shanghai, China.
Background:
Whether preoperative coronavirus disease 2019 (COVID-19) can affect postoperative neurological outcomes remains unknown. This study aimed to investigate the role of COVID-19-related risk factors (i.e., surgical timing following COVID-19 diagnosis and COVID-19 disease severity) on postoperative delirium (POD).
Materials And Methods:
We performed a secondary analysis of an observational cohort study. Adult patients who underwent elective, noncardiac surgery under general anesthesia were included. Multivariable logistic regression was used to assess the impact of surgical timing relative to COVID-19 (605 individuals) and COVID-19 severity (573 individuals) on POD.
Results:
After adjustment for baseline characteristics, patients who underwent surgery < 7 weeks after COVID-19 diagnosis (adjusted odds ratio, 95% confidence interval: 3.33, 1.43-7.74, P = 0.005), but not those who received surgery ≥ 7 weeks post-infection, had an increased risk of POD, compared with COVID-19-negative patients. Symptomatic infections (adjusted odds ratio, 95% confidence interval: 3.31, 1.46-7.48, P = 0.004), rather than asymptomatic infections, were associated with POD. These results remained consistent across several sensitivity analyses. In the subgroup analyses by age, recent COVID-19 (< 7 weeks) preceding surgery and symptomatic infections were predictors of POD only among patients under 65 years of age. An interplay between COVID-19-related risk factors affected the COVID-19-induced risk of POD. The risk was only increased in symptomatic patients who received surgery < 7 weeks after having COVID-19.
Conclusion:
Recent COVID-19 within 7 weeks preceding surgery and symptomatic infections are associated with POD. Complementary studies are needed to corroborate the impact of preoperative COVID-19 on postoperative neurological complications.
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