Surgery within 8 weeks of recovery among COVID-19 patients not tied to adverse outcomes: JAMA

The findings of a research results recently published in JAMA Network shows that, regardless of when the COVID-19 infection occurred during the preceding 60 days, there was no correlation between recent COVID-19 infection and likelihood of unfavorable postoperative outcomes. 

For patients who have just recovered from COVID-19, the American Society of Anesthesiologists issued suggestions on when to schedule elective surgery. The best time to have surgery in relation to immunization and infection has been the subject of several contradicting recent research. To determine the likelihood of unfavorable surgical outcomes among patients with recent COVID-19 infection, a study among a sizable veteran population was simulated. Those having infections in the 30 or 60 days before surgery, according to William O'Brien and colleagues, would be at higher risk than patients without infections.

This cohort research used pseudorandomization to compare the control (without a recent infection) to two mutually exclusive exposures in a target trial simulation (most recent infection in preoperative days 1-30 or 31-60). Patients who met the criteria underwent major surgery between January 1 and September 30, 2021. (Alpha and Delta strain prevalence). Reverse transcription-polymerase chain reaction testing was mandated prior to surgery, and immunization was advised for all participants. There were no oral outpatient treatments used. While the risk to participants was deemed to be low, the Veterans Affairs Boston institutional review board authorized both the research and a waiver of informed consent. The STROBE reporting manual was adhered to.

The end goal was defined as any of the following within 30 days of surgery: mortality, central nervous system outcomes, cardiac events, central nervous system outcomes, surgical infection, respiratory outcomes, or thromboembolic events. As a function of exposure group, perioperative variables (because they weren't known at time zero), and any imbalanced propensity score covariates after weighting, weighted logistic regression computed the odds ratio (OR) of any outcome.

The key findings of this study were:

In 123 hospitals, 29 093 patients had surgery in total. The mean (SD) duration of stay for the 15 553 surgical operations (53.5%) completed for inpatients was 5.0 (8.5) days. 

Between infection and surgery, the median interval was 30 days (IQR, 13-44 days). 

1337 of 28 635 patients (4.7%) in the group without COVID-19, 18 of 238 (7.6%) in the group with a 1- to 30-day infection, and 7 of 220 (3.2%) in the group with a 31- to 60-day infection experienced adverse postoperative outcomes. 

The odds ratios (ORs) for postoperative outcomes were 1.40 in patients with infection in preoperative days 1 to 30 and 0.68 in patients with infection in preoperative days 31 to 60.

According to the most recent research, the choice to proceed should be made based on clinical judgment rather than a predetermined amount of time following infection.

Reference: 

O’Brien, W. J., Gupta, K., & Itani, K. M. F. (2023). Estimated Risk of Adverse Surgical Outcomes Among Patients With Recent COVID-19 Infection Using Target Trial Emulation Methods. In JAMA Network Open (Vol. 6, Issue 3, p. e234876). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.4876