The Risk of Postoperative Complications following Major Elective Surgery in Active or Resolved COVID-19 in the United States.

OBJECTIVE To assess the association between timing of surgery relative to development of Covid-19 and the risks of postoperative complications. SUMMARY BACKGROUND DATA It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications. METHODS The risk of postoperative complications for patients with Covid-19 undergoing 18 major, elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; i.e., surgery performed: 1) before January 1st, 2020 ("pre-Covid-19"), 2) 0-4 weeks after SARS-CoV-2 infection ("peri-Covid-19"), 3) 4-8 weeks days after infection ("early post-Covid-19") and, 4) >8 weeks after infection ("late post-Covid-19"). RESULTS Of the 5,479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia (aOR, 6.46; 95% CI: 4.06-10.27), respiratory failure (aOR, 3.37; 95% CI: 2.20-5.17), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53) and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR 2.44, 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients. CONCLUSIONS Major, elective surgery 0-4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4-8 weeks after SARS-CoV-2 infection is still associated with an increased risk of pneumonia while surgery eight weeks after Covid-19 diagnosis is not associated with increased complications.