1. COVID-19 infected patients were found to be at an increased risk of postoperative pulmonary and septic complications compared with a matched, non-infected cohort.
Evidence Level Rating: 2 (Good)
Numerous reports have indicated high rates of significant post-operative complications among COVID-19 positive patients. Given the magnitude and severity of the ongoing pandemic, this propensity-matched analysis making use of the U.S. Veterans Health Administration (VA) records evaluated the contribution of COVID-19 infection to adverse postoperative outcomes, which may be used to inform decision making moving forward. The four primary outcomes were measured over 30 days and included mortality, readmission, reoperation, and hospital length of stay (LOS). Propensity matching resulted in final cohorts of 432 COVID-19 positive (mean [SD] age = 65.1 [12.7] years, 92.1% male) and 1,256 negative (mean [SD] age = 64.8 [12.3] years, 93.2% male) patients. After matching, COVID-19 positive patients demonstrated significantly longer median LOS (7 vs. 5 days, p < 0.001), but did not demonstrate a higher risk of mortality, reoperation, or readmission. However, it was found that infected patients had higher 30-day rates of pneumonia (20.6% vs. 6.0%, p < 0.001), postoperative mechanical ventilation (7.6% vs. 4.1%, p = 0.01), and ARDS (17.1% vs. 6.8%, p < 0.001). Furthermore, infected patients had higher rates of septic shock (13.7% vs. 6.8%, p < 0.001) and ischemic stroke (5.8% vs. 2.9%, p = 0.01). While propensity matching cannot control for all variables, COVID-19 positive patients undergoing surgery were found to be at an increased risk of pulmonary and septic complications in the postoperative period. These data underscore the importance of preprocedural screening for COVID-19 infection and suggest delaying surgery up to or beyond 30 days for patients with a high burden of risk.
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