| Popis: |
Determine mid-term postoperative outcomes among COVID-19-positive patients compared to those who never tested positive before surgery.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.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.Of 153,741 surgical patients, 4,778 COVID(+) were matched to 14,101 COVID(-). COVID(+) status was associated with higher postoperative mortality (P0.0001) 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.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. |
