Author: Erika Powers
Among patients undergoing planned or emergency orthopaedic surgery, the rate of postoperative oxygen requirements, pneumonia, and mortality were significantly higher among those who had tested positive for coronavirus disease 2019 (COVID-19) within the 30 days prior to surgery than those without, according to a study presented at Anesthesiology 2021, the Annual Meeting of the American Society of Anesthesiologists (ASA).
There were also statistically significant differences in length of stay and readmission within 1 month of discharge between both cohorts
“Throughout the pandemic in New York City, urgent and emergent orthopaedic procedures were performed at our institution, despite the lack of evidence to guide perioperative decision-making,” explained Uchenna Umeh, MD, New York University Langone Health, New York, New York. “We wanted to understand how COVID-19 infection affected mortality, perioperative complication rates, and hospital metrics for patients undergoing orthopaedic procedures requiring anaesthesia care.”
To do so, the researchers analysed data from 51 patients who tested positive for COVID-19 within 1 month before undergoing orthopaedic surgery, between March 1, 2020, and June 30, 2020. Patients were matched with a similar cohort of patients who underwent orthopaedic surgery between October 1, 2019, and December 21, 2019.
Postoperative pneumonia occurred in 12 (23.5%) patients in the COVID-19 cohort compared with none in the matched control group (P = .0005). Postoperative oxygen requirement also occurred at a significantly higher rate in the COVID-19 group (33.3% vs 13.3%; P = .01).
There were 8 (15.7%) deaths in the COVID-19 group compared with 1 (19%) in the control group (P = .02).
Length of stay ((8.10 ± 9.01 days vs 4.59 ± 4.69 days; P = 0.002) and readmission within 1 month of discharge (38.8% vs 8.2%; P = .0006) were significantly higher in the COVID-19 cohort.
When analysing preoperative variables and postoperative outcomes, the researchers found that diabetes and hypertension lead to worse outcomes in the COVID-19 cohort. Emergency surgery led to worse outcomes for both groups.
“These results confirm the deleterious effects of COVID-19 on cardiopulmonary function,” said Dr. Umeh. “It is important to consider the risks associated with COVID-19 infection during the pre-surgical and perioperative phases.”