Association of Time to Surgery After COVID-19 Infection With Risk of Postoperative Cardiovascular Morbidity

Abstract

Importance: The time interval between COVID-19 infection and surgery is a potentially modifiable but understudied risk factor for postoperative complications.

Objective: To examine the association between time to surgery after COVID-19 diagnosis and the risk of a composite of major postoperative cardiovascular morbidity events within 30 days of surgery.

Design, setting, and participants: This single-center, retrospective cohort study was conducted among 3997 adult patients (aged ≥18 years) with a previous diagnosis of COVID-19, as documented by a positive polymerase chain reaction test result, who were undergoing surgery from January 1, 2020, to December 6, 2021. Data were obtained through Structured Query Language access of an existing perioperative data warehouse. Statistical analysis was performed March 29, 2022.

Exposure: The time interval between COVID-19 diagnosis and surgery.

Main outcomes and measures: The primary outcome was the composite occurrence of major cardiovascular comorbidity, defined as deep vein thrombosis, pulmonary embolism, cerebrovascular accident, myocardial injury, acute kidney injury, and death within 30 days after surgery, using multivariable logistic regression.

Results: A total of 3997 patients (2223 [55.6%]; median age, 51.3 years [IQR, 35.1-64.4 years]; 667 [16.7%] African American or Black; 2990 [74.8%] White; and 340 [8.5%] other race) were included in the study. The median time from COVID-19 diagnosis to surgery was 98 days (IQR, 30-225 days). Major postoperative adverse cardiovascular events were identified in 485 patients (12.1%). Increased time from COVID-19 diagnosis to surgery was associated with a decreased rate of the composite outcome (adjusted odds ratio, 0.99 [per 10 days]; 95% CI, 0.98-1.00; P = .006). This trend persisted for the 1552 patients who had received at least 1 dose of COVID-19 vaccine (adjusted odds ratio, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .04).

Conclusions and relevance: This study suggests that increased time from COVID-19 diagnosis to surgery was associated with a decreased odds of experiencing major postoperative cardiovascular morbidity. This information should be used to better inform risk-benefit discussions concerning optimal surgical timing and perioperative outcomes for patients with a history of COVID-19 infection.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Boncyk reported receiving personal fees from Sedana Medical outside the submitted work. Dr Rengel reported receiving grants from Vanderbilt Faculty Research Scholars outside the submitted work. Mr Li reported holding stock in Johnson & Johnson and Roche Holding AG outside the submitted work. Dr Freundlich reported receiving grants from the National Heart, Lung, and Blood Institute and the National Center for Advancing Translational Sciences during the conduct of the study and personal fees from Phillips Healthcare, University of Massachusetts, and Oak Hill Clinical Informatics and holding stock in 3M outside the submitted work. No other disclosures were reported.

Figures

Figure.. Risk of Postoperative Adverse Outcomes Shown by Level of Continuous Patient Characteristics

A, Incidence of composite outcome. Shaded regions indicate 95% CIs. B, Patients undergoing surgery after SARS-CoV-2 infection.