Preoperative SARS-CoV-2 infection increases risk of early postoperative cardiovascular complications following noncardiac surgery

Abstract

As the COVID-19 pandemic progresses to an endemic phase, a greater number of patients with a history of COVID-19 will undergo surgery. Major adverse cardiovascular and cerebrovascular events (MACE) are the primary contributors to postoperative morbidity and mortality; however, studies assessing the relationship between a previous SARS-CoV-2 infection and postoperative MACE outcomes are limited. Here, we analyzed retrospective data from 457,804 patients within the N3C Data Enclave-the largest national, multi-institutional dataset on COVID-19 in the United States. 7.4% of patients had a history of COVID-19 prior to surgery. When controlling for comorbidities, age, race, and risk of surgery, patients with preoperative COVID-19 had an increased risk for 30-day postoperative MACE. MACE risk was influenced by an interplay between COVID-19 disease severity and time between surgery and infection; in those with mild disease, MACE risk was not increased even among those undergoing surgery within 4 weeks following infection. In those with moderate disease, risk for postoperative MACE was mitigated 8 weeks after infection, while patient with severe disease continued to have elevated postoperative MACE risk even after waiting 8 weeks. Being fully vaccinated decreased the risk for postoperative MACE in both patients with no history of COVID-19 and in those with breakthrough COVID-19 infection. Together, our results suggest that a thorough assessment of the severity, vaccination status, and timing of SARS-CoV-2 infection must be a mandatory part of perioperative stratification.

Severity of Prior COVID-19 is Associated with Postoperative Outcomes Following Major Inpatient Surgery

“…Those with mild disease were not at an increased risk of adverse postoperative outcomes even when undergoing surgery within 4 weeks of an acute infection, which is consistent with previous work. 15 We also provide a more detailed measurement of the association across a spectrum of specific postoperative complications. For example, patients with mild disease had no increased odds for all assessed adverse events, moderate disease showed an elevated risk for all assessed complications, whereas those with severe disease had increased odds of all assessed complications with a magnitude of effect multiple fold greater.…”

“…This is in line with numerous other studies supporting the prioritization of preoperative vaccination. 15,[24][25][26] The data presented in this study included patients who underwent surgery before March 2023, and thus reflect the environment as the pandemic shifts to an endemic phase. For comparison, the data collected for the COVIDSurg study was in October 2020, and the Deng and colleagues study of patients in the United States included surgeries performed until June 2021.…”

“…Most current guidelines for managing COVID-19 in the perioperative setting are not stratified by disease severity; however, there seems to be a relationship between the severity of infection and postoperative outcomes. 15 Prior studies also show that compared with those with asymptomatic or mild disease, postoperative intensive care unit stay is longer among those with severe COVID-19 who require hospitalization. 16 This suggests that including the severity of SARS-CoV-2 infection in surgical wait time guidelines may facilitate more personalized patient recommendations and prevent unnecessary delays to surgery for those with less severe infections.…”