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

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


Journalamerican journal of surgery
Article typeJournal research article – Clinical research
Publication date – Apr – 2021
Authors – Nikhil K. Prasad, Rachel Lake ,Brian R. Englum, Douglas Turner ,Tariq Siddiqui ,Minerva Mayorga-Carlin, John D. Sorkin ,Brajesh K. Lal
KeywordsCOVID-19 testing, Elective surgical procedure, Postoperative complications
Open access – Yes
SpecialityCritical care
World region Northern America
Country: United States of America
Language – English
Submitted to the One Surgery Index on April 22, 2021 at 1:30 am
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[-/+]), before surgery (COVID[+/−]) or negative throughout (COVID[−/−]). The cumulative incidence, risk factors for and complications of COVID[-/+], 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[-/+] 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[-/+] group. After matching on current procedural terminology code and month of procedure, multivariable Poisson regression estimated the complication rate ratio for the COVID[-/+] group vs. COVID[−/−] to be 8.4 (C.I. 4.9–14.4) 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.

OSI Number – 21027

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