Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study

Lapidus, Nathanaël; Garnier, Marc; Constantin, Jean-Michel; Cinotti, Raphaël; Daoui, Chafia; Léone, Marc; Lapidus, Nathanaël; Hafiani, El Mahdi; Quesnel, Christophe; Imauven, Olivier; Lasocki, Sigismond; Rineau, Emmanuel; Léger, Maxime; Déserts, Marc Danguy des; Schmitt, Johan; Ariès, Philippe; Gouel-Cheron, Aurélie; Voulgaropoulos, Julia; Soldan, Laura; Deransy, Romain; Laurent, Quentin; Gayat, Étienne; Verdonk, Franck; Chaouche, Sabrina; Cambriel, Amélie; Degos, Vincent; Dupont, Julie; Daoud, Laura; Margetis, Dimitri; Salettes, Romain; Favreau, Malory; Noll, Eric; Pottecher, Julien; Diemunsch, Sophie; Abrard, Stanislas; Bidon, Cyril; Roy, C P; Destruhaut, Grégory; Ottolenghi, Laetitia; Edouard, Damien; Lecinq, Agnès; Mercier, Frédéric; Cirenei, Cédric; Garrigue, Delphine; Jozefowicz, Elsa; Pariès, Marie; Espitalier, Fabien; Piat, Charlène; Descamps, Richard; Duchesne, Maëlle; Sigaut, Stéphanie; Thion, Laurie-Anne; Renard, Julie; Brocas, E.; Zbidi, Besma; Fki, Mohamed; Quemeneur, Cyril; Dufour, Guillaume; Bucciero, Mario; Rochon, Charles-Edouard; Delerue, Céline; Trehel-Tursis, Virginie; Raft, Julien; Rangeard, Olivier; Thiriet, Claire; Lagarde, Kevin; Pollet, Angélina; Pelen, Félix; Caillard, Anaïs; Penven, Philippe; Huet, Olivier; Puel, Floriane; Pichon, Xavier; Ligneres, Laetitia; Bleuze, Pauline; Deryckere, Stephanie; Velly, Lionel; Simeone, Pierre; Andrianjatovo, Hery; Chipouline, Youri; Boolad, Mouna; Frasca, Denis; Plouviez, Quentin; Plaud, Benoît; Roland, E.; Cheron-Leroy, Delphine; Figueiredo, Samy; Blanié, Antonia; Joannès-Boyau, Olivier; Monziols, Simon; Robin, Jean‐Jacques; Biais, Matthieu; Courson, Hugues de; Degryse, C.; Do-Khac, Marie; Bonnet, Marie‐Pierre; Mazeraud, Aurélien; Bardon, Jean; Bouchereau, Eléonore; Pastène, Bruno; Bézulier, Karine; Charbonneau, Hélène; Mrozek, Ségolène; Mayeur, Nicolas; Lopez, Sandrine

doi:10.1016/j.eclinm.2023.101881

Cited by 12 publications

(13 citation statements)

References 19 publications

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“…A prospective observational study of 4928 patients who underwent surgery during the Omicron phase of the pandemic included 705 patients with pre‐operative SARS‐CoV‐2 infection [18]. Infection up to 8 weeks pre‐operatively was not associated with increased risks of postoperative pulmonary complications compared with no history of infection (3.4% vs. 2.75%; p = 0.83).…”

Section: Prevention Of Peri‐operative Sars‐cov‐2 Infectionmentioning

confidence: 99%

“…This risk assessment should inform shared decision‐making between the multidisciplinary team and patient, with documentation of risks and benefits of the timing of surgery and the decision‐making process. Patients with persistent symptoms, moderate‐to‐severe COVID‐19 or who are immunosuppressed may still have increased risks beyond 7 weeks [18, 19]; these patients may require specialist assessment and individualised, multidisciplinary peri‐operative management with consideration of further delay.…”

Section: Prevention Of Peri‐operative Sars‐cov‐2 Infectionmentioning

confidence: 99%

“…Data before the era of Omicron and widespread vaccination highlighted that surgery within 7 weeks of SARS-CoV-2 infection was associated with an increased risk of morbidity and mortality [3,23]. More recent data have suggested that risks associated with surgery within 7 weeks of infection may be more modest than in previous phases of the pandemic [18,20]. In the Omicron post-vaccination era, a population-based data platform analysis in England showed that surgery 2 weeks, 2-4 weeks, 4-7 weeks and > 7 weeks after SARS-CoV-2 infection was associated with a 30-day mortality rate of 1.1%, 0.5%, 0.3% and 0.2%, respectively [20].…”

Section: Timing Of Elective Surgery After Sars-cov-2 Infectionmentioning

confidence: 99%

“…The increasing scale of the surgical backlog and implications for population health of delayed access to surgical care have underscored the need for mitigating barriers to surgery [14][15][16], although the overall impact of delayed care due to SARS-CoV-2 guidance is thought to be small [17]. Finally, data have begun to emerge on the impact of peri-operative infection on postoperative outcomes in the Omicron variant and vaccination era [18][19][20].…”

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confidence: 99%

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Timing of elective surgery and risk assessment after SARS‐CoV‐2 infection: 2023 update

et al. 2023

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Summary Guidance for the timing of surgery following SARS‐CoV‐2 infection needed reassessment given widespread vaccination, less virulent variants, contemporary evidence and a need to increase access to safe surgery. We, therefore, updated previous recommendations to assist policymakers, administrative staff, clinicians and, most importantly, patients. Patients who develop symptoms of SARS‐CoV‐2 infection within 7 weeks of planned surgery, including on the day of surgery, should be screened for SARS‐CoV‐2. Elective surgery should not usually be undertaken within 2 weeks of diagnosis of SARS‐CoV‐2 infection. For patients who have recovered from SARS‐CoV‐2 infection and who are low risk or having low‐risk surgery, most elective surgery can proceed 2 weeks following a SARS‐CoV‐2 positive test. For patients who are not low risk or having anything other than low‐risk surgery between 2 and 7 weeks following infection, an individual risk assessment must be performed. This should consider: patient factors (age; comorbid and functional status); infection factors (severity; ongoing symptoms; vaccination); and surgical factors (clinical priority; risk of disease progression; grade of surgery). This assessment should include the use of an objective and validated risk prediction tool and shared decision‐making, taking into account the patient's own attitude to risk. In most circumstances, surgery should proceed unless risk assessment indicates that the risk of proceeding exceeds the risk of delay. There is currently no evidence to support delaying surgery beyond 7 weeks for patients who have fully recovered from or have had mild SARS‐CoV‐2 infection.

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Section: Prevention Of Peri‐operative Sars‐cov‐2 Infectionmentioning

confidence: 99%

Section: Prevention Of Peri‐operative Sars‐cov‐2 Infectionmentioning

confidence: 99%

Section: Timing Of Elective Surgery After Sars-cov-2 Infectionmentioning

confidence: 99%

mentioning

confidence: 99%

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Timing of elective surgery and risk assessment after SARS‐CoV‐2 infection: 2023 update

et al. 2023

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“…7 The median age of COVID-19 patients who died was 82 yr. 7 Studies comprising patient cohorts who were infected during the Omicron period and/or were highly immunized found that preoperative COVID-19 had minimal associations with postoperative respiratory complications. 8,9 Major strengths of the study by Aziz et al include the high-quality prospective data collected through an established…”

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confidence: 99%

COVID-19 and Surgery: Getting Back to Business

Myles

2024

Anesthesiology

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I n the first phase of the COVID-19 pandemic, it became apparent that adult patients with a diagnosis of COVID-19 before or after surgery were at increased risk of severe respiratory and thrombotic complications, with one major study reporting that close to one in four patients died within 30 days of surgery. 1 Most elective surgery was being canceled around the world, as intensive care units were overfull with critically ill patients with COVID-19 infection, and hospital staff required upskilling and supply of personal protective equipment. Deferred cancer and cardiovascular screening programs, and canceled surgery, had their own consequences. 2,3 Thankfully, this was followed by the rapid development and widespread uptake of both effective vaccines and drug treatments for In this issue of Anesthesiology, Aziz et al. 5 undertook a retrospective observational cohort study of patients presenting for elective inpatient surgery across 37 U.S. academic and community hospitals from April 2020 to April 2021. Surgical patients who had tested positive for COVID-19 were compared with propensity-matched controls who did not have a recorded positive COVID-19 test. Cases were matched for age, sex, race, American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status, solid tumor, institution, and comorbidities. Patient outcomes were further stratified to determine whether timing of a positive test in relation to surgery affected risk of adverse outcomes. Aziz et al. found that 30-day mortality occurred in 229 of 4,951 patients (4.6%) with a positive test for COVID-19 (i.e., current or very recent infection) compared with 122 of 4,951 matched patients (2.5%) without a recent positive test for COVID-19 (adjusted odds ratio, 1.63; 95% CI, 1.38 to 1.91). Those with a positive test were also more likely to have postoperative pulmonary complications (14% vs. 10%;This editorial accompanies the article on p. 195. This article has an audio podcast.

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Association of preoperative coronavirus disease 2019 with mortality, respiratory morbidity and extrapulmonary complications after elective, noncardiac surgery: An observational cohort study

Liu,

Hu,

Yang

et al. 2024

Journal of Clinical Anesthesia

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Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study

Cited by 12 publications

References 19 publications

Timing of elective surgery and risk assessment after SARS‐CoV‐2 infection: 2023 update

Timing of elective surgery and risk assessment after SARS‐CoV‐2 infection: 2023 update

COVID-19 and Surgery: Getting Back to Business

Association of preoperative coronavirus disease 2019 with mortality, respiratory morbidity and extrapulmonary complications after elective, noncardiac surgery: An observational cohort study

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