COVID-19 and Surgery: Getting Back to Business

Abstract

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.