Increased time from coronavirus disease 2019 (COVID-19) diagnosis to surgery was associated with a decreased odds of experiencing major postoperative cardiovascular morbidity, according to a study published in JAMA Network Open.
John M. Bryant, MD, Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues noted that “this information should be used to better inform risk-benefit discussions concerning optimal surgical timing and perioperative outcomes for patients with a history of COVID-19 infection.”
These findings came from a single-centre retrospective cohort study conducted among 3,997 adult patients with a previous diagnosis of COVID-19 who were undergoing surgery from January 1, 2020, to December 6, 2021. The primary outcome was the composite occurrence of major cardiovascular comorbidity, defined as deep vein thrombosis (DVT), pulmonary embolism (PE), cerebrovascular accident (CVA), myocardial injury, acute kidney injury (AKI), and death within 30 days after surgery.
The median age of the cohort was 51.3 years, comprising 2,223 (55.6%) female patients. The median time from COVID-19 diagnosis to surgery was 98 days, with 1,394 patients (34.9%) undergoing surgery within 7 weeks of a confirmed COVID-19 diagnosis.
Overall, 61 patients (1.5%) developed DVT, 16 patients (0.4%) met criteria for PE, 29 patients (0.7%) had CVA, 116 patients (2.9%) had myocardial injury, and 363 patients (9.1%) had AKI within 30 days of surgery. In addition, 79 patients (2.0%) died within 30 days after surgery. The overall incidence of the primary composite outcome was 12.1% (n = 485).
Results of the multivariable logistic regression demonstrated that increasing time from positive severe acute respiratory syndrome coronavirus 2 test result to surgery was associated with a decreasing rate of the primary composite outcome (adjusted OR [aOR], 0.99 [per 10 days]; 95% confidence interval [CI], 0.98-1.00; P = 0.006), whereas older age (aOR, 1.13 [per 10 years of age]; 95% CI, 1.05-1.22; P = 0.002), male sex (aOR, 1.51; 95% CI, 1.18-1.93; P < 0.001), Black or African American race (aOR, 2.01 [vs White race]; 95% CI, 1.50-2.70; P < 0.001), higher American Society of Anesthesiologists (ASA) classification (aOR, 2.43 [per 1 level]; 95% CI, 1.97-2.99; P < 0.001), ASA emergency status (aOR, 1.49; 95% CI, 1.02-2.17; P = 0.04), urologic procedure (aOR, 1.98; 95% CI, 1.37-2.87; P < 0.001), and 8 Elixhauser comorbidities (cardiac arrhythmias, neurodegenerative disorders, kidney failure, lymphoma, solid tumor, coagulopathy, weight loss, and fluid and electrolyte disorders) were independently associated with an increased likelihood of the primary outcome measure.
No substantial change was observed in the estimates of association between the subgroup receiving at least 1 dose of a vaccine (1,552 patients; aOR, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = 0.04) and the unvaccinated subgroup (2,445 cases; aOR, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = 0.02).
A sensitivity analysis excluding the 79 instances of mortality was congruent with the primary analysis (aOR, 0.99 [per 10-day increase]; 95% CI, 0.98-1.00; P = 0.007). Meanwhile, a sensitivity analysis including the 244 patients (6.1%) with postoperative pulmonary complications resulted in a secondary composite outcome incidence rate of 14.7% (n = 588), with findings consistent with the primary analysis (aOR, 0.99 [per 10 days]; 95% CI, 0.98-1.00; P = 0.002).
“The results of this cohort study suggest that there was a time-dependent association between time from COVID-19 diagnosis to surgical intervention and a composite outcome of DVT, PE, CVA, myocardial injury, AKI, or death,” the authors remarked. “This association remained in multiple sensitivity analyses accounting for competing risk of death, pulmonary complications, severity of symptoms, and vaccination status.”
“Understanding the potential benefits associated with delaying surgery provides a key step in clinicians’ ability to optimise surgical timing for the increasing population of patients who have been infected with COVID-19,” the authors wrote, noting that “additional research is needed to determine the effect of the dynamic management of this disease and of newer COVID-19 variants on the association we have detected.”
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