Preoperative SARS-CoV-2 Infection Increases Risk of Early Postoperative Cardiovascular Complications Following Non-Cardiac Surgery by Gopika SenthilKumar

Am J Physiol Heart Circ Physiol. 2023 Mar 17. doi: 10.1152/ajpheart.00097.2023. Online ahead of print.

ABSTRACT

As the COVID-19 pandemic progresses to an endemic phase, a greater number of patients with a history of COVID-19 will undergo surgery. Major adverse cardiovascular and cerebrovascular events (MACE) are the primary contributors to postoperative morbidity and mortality; however, studies assessing the relationship between a previous SARS-CoV-2 infection and postoperative MACE outcomes are limited. Here, we analyzed retrospective data from 457,804 patients within the N3C Data Enclave-the largest national, multi-institutional dataset on COVID-19 in the United States. 7.4% of patients had a history of COVID-19 prior to surgery. When controlling for comorbidities, age, race, and risk of surgery, patients with preoperative COVID-19 had an increased risk for 30-day postoperative MACE. MACE risk was influenced by an interplay between COVID-19 disease severity and time between surgery and infection; in those with mild disease, MACE risk was not increased even among those undergoing surgery within 4 weeks following infection. In those with moderate disease, risk for postoperative MACE was mitigated 8 weeks after infection, while patient with severe disease continued to have elevated postoperative MACE risk even after waiting 8 weeks. Being fully vaccinated decreased the risk for postoperative MACE in both patients with no history of COVID-19 and in those with breakthrough COVID-19 infection. Together, our results suggest that a thorough assessment of the severity, vaccination status, and timing of SARS-CoV-2 infection must be a mandatory part of perioperative stratification.

PMID:36930659 | DOI:10.1152/ajpheart.00097.2023