ABSTRACT
OBJECTIVE: Determine mid-term postoperative outcomes among COVID-19-positive patients compared to those who never tested positive before surgery. BACKGROUND: COVID-19 is thought to be associated with prohibitively high rates of postoperative complications. However, prior studies have only evaluated 30-day outcomes and most did not adjust for demographic, clinical, or procedural characteristics. METHODS: We analyzed data from surgeries performed at all Veterans Affairs hospitals between March 2020-2021. Kaplan-Meier curves compared trends in mortality and cox-proportional hazards models estimated rates of mortality and pulmonary, thrombotic, and septic postoperative complications between patients with a positive preoperative SARS-CoV-2 test (COVID (+)) and propensity score matched COVID(-) patients. RESULTS: Of 153,741 surgical patients, 4,778 COVID(+) were matched to 14,101 COVID(-). COVID(+) status was associated with higher postoperative mortality (P<0.0001) with a 6-month survival of 94.2% (95% CI 93.2-95.2 ) versus 96.0% (95.7.0-96.4 ) in COVID(-) . The highest mortality was in the first 30 postoperative days. Hazards for mortality and postoperative complications in COVID(+) decreased with increasing time between testing COVID(+) and date of surgery. COVID(+) patients undergoing elective surgery had similar rates of mortality, thrombotic and septic complications, but higher rates of pulmonary complications than COVID(-) patients. CONCLUSION: This is the first report of mid-term outcomes among COVID-19 patients undergoing surgery. COVID-19 is associated with decreased overall and complication-free survival primarily in the early postoperative period, delaying surgery by 5 weeks or more reduces risk of complications. Case urgency has a multiplicative effect on short- and long-term risk of postoperative mortality and complications.
ABSTRACT
BACKGROUND: There are currently no data to guide decisions about delaying surgery to achieve full vaccination. METHODS: We analyzed data from patients undergoing surgery at any of the 1,283 VA medical facilities nationwide and compared postoperative complication rates by vaccination status. RESULTS: Of 87,073 surgical patients, 20% were fully vaccinated, 15% partially vaccinated, and 65% unvaccinated. Mortality was reduced in full vaccination vs. unvaccinated (Incidence Rate Ratio 0.77, 95% CI [0.62, 0.94]) and partially vaccinated vs. unvaccinated (0.75 [0.60, 0.94]). Postoperative COVID-19 infection was reduced in fully (0.18 [0.12, 0.26]) and partially vaccinated patients (0.34 [0.24, 0.48]). Fully vaccinated compared to partially vaccinated patients, had similar postoperative mortality (1.02, [0.78, 1.33]), but had decreased COVID-19 infection (0.53 [0.32, 0.87]), pneumonia (0.75 [0.62, 0.93]), and pulmonary failure (0.79 [0.68, 0.93]). CONCLUSIONS: Full and partial vaccination reduces postoperative complications indicating the importance of any degree of vaccination prior to surgery.