Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening

Abstract

Background: The COVID-19 pandemic has necessitated the adoption of protocols to minimize risk of periprocedural complications associated with SARS-CoV-2 infection. This typically involves a preoperative symptom screen and nasal swab RT-PCR test for viral RNA. Asymptomatic patients with a negative COVID-19 test are cleared for surgery. However, little is known about the rate of postoperative COVID-19 positivity among elective surgical patients, risk factors for this group and rate of complications. Methods: This prospective multicenter study included all patients undergoing elective surgery at 170 Veterans Health Administration (VA) hospitals across the United States. Patients were divided into groups based on first positive COVID-19 test within 30 days after surgery (COVID[-/þ]), before surgery (COVID[þ/À]) or negative throughout (COVID[À/À]). The cumulative incidence, risk factors for and complications of COVID[-/þ], were estimated using univariate analysis, exact matching, and multivariable regression. Results: Between March 1 and December 1, 2020 90,093 patients underwent elective surgery. Of these, 60,853 met inclusion criteria, of which 310 (0.5%) were in the COVID[-/þ] group. Adjusted multivariable logistic regression identified female sex, end stage renal disease, chronic obstructive pulmonary disease, congestive heart failure, cancer, cirrhosis, and undergoing neurosurgical procedures as risk factors for being in the COVID[-/þ] group. After matching on current procedural terminology code and month of procedure, multivariable Poisson regression estimated the complication rate ratio for the COVID[-/þ] group vs. COVID[À/À] to be 8.4 (C.I. 4.9e14.4) for pulmonary complications, 3.0 (2.2, 4.1) for major complications, and 2.6 (1.9, 3.4) for any complication. Discussion: Despite preoperative COVID-19 screening, there remains a risk of COVID infection within 30 days after elective surgery. This risk is increased for patients with a high comorbidity burden and those undergoing neurosurgical procedures. Higher intensity preoperative screening and closer postoperative monitoring is warranted in such patients because they have a significantly elevated risk of postoperative complications.

Partial COVID-19 vaccination associated with reduction in postoperative mortality and SARS-CoV-2 infection

“…We have previously reported significant elevations in mortality, reoperation, readmission, and pulmonary complications among individuals who test positive for COVID-19 in the postoperative period. 12 The reduction in postoperative COVID-19 infection shown in this report may be responsible for the lower mortality rate after a single dose of mRNA vaccine. These findings are corroborated by a recent report from the Israeli vaccination drive, in which a single dose of vaccine was 72% effective at reducing mortality after two weeks.…”

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

“…If postoperative patients develop symptoms suggestive of COVID-19, a polymerase chain reaction test should be performed. In particular, Prasad et al report that female patients with end-stage renal disease, congestive heart failure, COPD, liver cirrhosis, cancer, or undergoing neurosurgical procedures are more likely to test positive for SARS CoV-2 after elective surgery [ 44 , 45 ]. It could also be useful to manage the periodic remote follow-up.…”

“…The necessary precautions should also be taken to prevent patients, especially those at high risk, from contracting the infection in the perioperative period. The size of this phenomenon, the positivity for SARS-CoV-2 found perioperatively, was defined in a systematic analysis conducted between March and December 2020 in the USA; the incidence stood at 5 positivity per 1000 procedures [ 44 ]. Female patients, those undergoing neurosurgery and those characterized by greater comorbidity, proved to have the highest probability of testing positive for SARS-CoV-2 in the immediate postoperative period [ 44 ].…”

“…The size of this phenomenon, the positivity for SARS-CoV-2 found perioperatively, was defined in a systematic analysis conducted between March and December 2020 in the USA; the incidence stood at 5 positivity per 1000 procedures [ 44 ]. Female patients, those undergoing neurosurgery and those characterized by greater comorbidity, proved to have the highest probability of testing positive for SARS-CoV-2 in the immediate postoperative period [ 44 ]. An increased incidence of both major complications and lengthening of hospital stay was also found in this population [ 44 ].…”

Risk and Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Corneal Transplantation: A Case–Control Study

“…33,34 The rate of developing SARS-CoV-2 infection within the first month after surgery in our study (2.9%) is comparable with that reported after elective surgery in other centers (0.5%-3.2%). [35][36][37][38] Among the individuals who had a SARS-CoV-2 infection, 35.7% (5/14) occurred during the month of July 2020 coinciding with the peak of cases in Miami-Dade County, which had an incidence of 6.89% (187,259 positive tests/2,716,940 individuals) and a positivity rate of 15.34% (187,259 positive tests/1,220,657 total tests) during that month. 39,40 In this study, individuals with a history of cardiovascular disease were at a significantly increased risk of developing SARS-CoV-2 infection during the first postoperative month, independently of the procedure received.…”