Study: COVID-19 could elevate risk of surgical mortality, complications

Editor's Note

Due to its impact on a variety of organ systems, COVID-19 could elevate perioperative risks even among patients with mild symptoms, according to a study published in the February 2024 issue of Anesthesiology.

Focused on patients presenting for elective inpatient surgery between April 2020 and April 2021, the retrospective observational cohort study also found elevated risk of pulmonary complications but not acute kidney injury as compared to matched controls. The risk was significantly more within 2 weeks of infection—an insight that could impact surgical decision-making.   

“Studies to date have included all surgical patients without refining a cohort to include those for whom surgical care may be reasonably delayed, thus providing little guidance for the more common situation of a patient who could delay surgery after a COVID-19 exposure if necessary,” the researchers wrote.  “To accurately weigh the risks and benefits of proceeding with a surgical intervention, an understanding of the perioperative risk associated with undergoing surgery and anesthesia after COVID-19 is necessary.”

Patients in the study presented for elective inpatient surgery across a multicenter cohort of academic and community hospitals. Those who had tested positive for COVID-19 were compared to controls who had received at least one previous COVID-19 test but without a known previous COVID-19–positive test. Specific results include:

• Thirty-day mortality occurred in 229 of 4,951 (4.6% of) COVID-19–exposed patients and 122 of 4,951 (2.5% of) controls.
• Acute kidney injury was observed in 172 of 1,814 (9.5%) exposed patients and 156 of 1,814 (8.6%) controls.
• Pulmonary complications were observed in 237 of 1,637 (14%) exposed patients and 164 of 1,637 (10%) controls.