Study compares Postoperative morbidity in cancer patients with and without a history of Covid infection

Cancer patients who have had Covid-19 may experience unfavorable outcomes after cancer surgery due to specific risk factors such as immunosuppression, chemotherapy, radiotherapy, and increased susceptibility to infection and malnutrition. Recent research paper is a prospective, comparative study conducted to examine the impact of Covid-19 infection history on postoperative morbidity and mortality in cancer patients undergoing elective surgery. The study aimed to compare the outcomes in post-Covid-19 (PC) and non-Covid-19 (NC) groups and explore the implications for surgical risk. A total of 414 patients were included, with 109 experiencing postoperative complications, and the study found that the PC group had a higher incidence of complications, particularly pulmonary complications, compared to the NC group. The overall mortality rate was 0.72%. The study also investigated the impact of different intervals between Covid-19 diagnosis and surgery and revealed a higher incidence of respiratory complications within 2-4 weeks after Covid-19 diagnosis, decreasing over time. Additionally, the study examined various factors associated with postoperative complications, such as age, hypothyroidism, and prognostic nutritional index (PNI), providing insights into risk stratification for surgical outcomes

Morbidity Risk Profile and Waiting Period Recommendations

The study employed the Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score to estimate morbidity and mortality risk, and it was observed that PC and NC groups had a comparable morbidity risk profile. The findings indicated that cancer patients with a history of Covid infection are at a higher risk of postoperative pulmonary complications, suggesting the need for a minimum holding period before surgery for asymptomatic patients and a longer waiting period for symptomatic patients. This recommendation aligns with updated guidelines advising a 7-8 week waiting period for elective surgeries after Covid-19 infection. It was also noted that older age, hypothyroidism, and low PNI were associated with a higher incidence of complications, providing valuable insights for preoperative risk assessment and patient counseling.

Enhancing Surgical Outcomes for Covid-19-Recovered Cancer Patients

Overall, the study contributes to the understanding of the impact of Covid-19 infection on postoperative outcomes in cancer patients undergoing elective surgery. The findings underscore the importance of risk stratification, proper prehabilitation, and postoperative care to improve perioperative outcomes for Covid-19-recovered cancer patients. The study's recommendations suggest a practical approach to optimize surgical outcomes in this patient population and provide valuable insights for future decision-making regarding the timing of elective surgeries for patients with a history of Covid-19 infection.

Key Points

1. The study was a prospective, comparative study that aimed to examine the impact of Covid-19 infection history on postoperative morbidity and mortality in cancer patients undergoing elective surgery.

2. The study included a total of 414 patients, with 109 experiencing postoperative complications. It revealed that the post-Covid-19 (PC) group had a higher incidence of complications, particularly pulmonary complications, compared to the non-Covid-19 (NC) group.

3. The overall mortality rate was found to be 0.72%. The study also looked at the impact of different intervals between Covid-19 diagnosis and surgery and found a higher incidence of respiratory complications within 2-4 weeks after Covid-19 diagnosis, decreasing over time.

4. The study used the Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score to estimate morbidity and mortality risk. It found that PC and NC groups had a comparable morbidity risk profile. Additionally, older age, hypothyroidism, and low prognostic nutritional index (PNI) were associated with a higher incidence of complications.

5. The study recommended a minimum holding period before surgery for asymptomatic patients and a longer waiting period for symptomatic patients with a history of Covid infection. It aligned with updated guidelines advising a 7-8 week waiting period for elective surgeries after Covid-19 infection.

6. Overall, the study emphasized the importance of risk stratification, proper prehabilitation, and postoperative care to improve perioperative outcomes for Covid-19-recovered cancer patients. It provided practical recommendations to optimize surgical outcomes in this patient population and offered valuable insights for future decision-making regarding the timing of elective surgeries for patients with a history of Covid-19 infection.

Reference –

Hemrajani M, Mongia P, Gupta P, Joad AK. Morbidity and mortality after elective cancer surgery—How does recent Covid‑19 infection impact outcome: A prospective, comparative study. J Anaesthesiol Clin Pharmacol 2024 DOI: 10.4103/joacp.joacp_232_23