Objective: To evaluate whether COVID-19 vaccination status or mode of anesthesia modified the temporal harms associated with surgery following coronavirus disease-2019 (COVID-19) infection. Background: Surgery shortly after COVID-19 infection is associated with higher rates of complications, leading to recommendations to delay surgery following COVID-19 infection when possible. However, prior studies were based on populations with low or no prevalence of vaccination. Methods: A retrospective cohort study of patients who underwent scheduled surgery in a health system from January 1, 2018 to February 28, 2022 (N = 228,913) was performed. Patients were grouped by time of surgery relative to COVID-19 test positivity: 0 to 4 weeks after COVID-19 ("early post-COVID-19"), 4 to 8 weeks after COVID-19 ("mid post-COVID-19"), > 8 weeks after COVID-19 ("late post-COVID-19"), surgery at least 30 days before subsequent COVID-19 ("pre-COVID-19"), and surgery with no prior or subsequent test positivity for COVID-19. Results: Among patients who were not fully vaccinated at the time of COVID-19 infection, the adjusted rate of perioperative complications for the early post-COVID-19 group was significantly higher than for the pre-COVID-19 group (relative risk: 1.55; P = 0.05). No significantly higher risk was identified between these groups for patients who were fully vaccinated (0.66; P = 1.00), or for patients who were not fully vaccinated and underwent surgery without general anesthesia (0.52; P = 0.83). Conclusions: Surgery shortly following COVID-19 infection was not associated with higher risks among fully vaccinated patients or among patients who underwent surgery without general anesthesia. Further research will be valuable to understand additional factors that modify perioperative risks associated with prior COVID-19 infection.

Objective: To develop an electronic health record-based risk model for perioperative medicine (POM) triage and compare this model with legacy triage practices that were based on clinician assessment. Summary of Background Data: POM clinicians seek to address the increasingly complex medical needs of patients prior to scheduled surgery. Identifying which patients might derive the most benefit from evaluation is challenging. Methods: Elective surgical cases performed within a health system 2014– 2019 (N = 470,727) were used to develop a predictive score, called the Comorbidity Assessment for Surgical Triage (CAST) score, using split validation. CAST incorporates patient and surgical case characteristics to predict the risk of 30-day post-operative morbidity, defined as a composite of mortality and major NSQIP complications. Thresholds of CAST were then selected to define risk groups, which correspond with triage to POM appointments of different durations and modalities. The predictive discrimination CAST score was compared with the surgeon’s assessments of patient complexity and the American Society of Anesthesiologists class. Results: The CAST score demonstrated a significantly higher discrimination for predicting post-operative morbidity (area under the receiver operating characteristic curve 0.75) than the surgeon’s complexity designation (0.63; P < 0.001) or the American Society of Anesthesiologists (0.65; P < 0.001) (Fig. 1). Incorporating the complexity designation in the CAST model did not significantly alter the discrimination (0.75; P = 0.098). Compared with the complexity designation, classification based on CAST score groups resulted a net reclassification improvement index of 10.4% (P < 0.001) (Table 1). Conclusion: A parsimonious electronic health record-based predictive model demonstrates improved performance for identifying pre-surgical patients who are at risk than previously-used assessments for POM triage.

No abstract