Study reports that delaying surgery post-COVID-19 reduces the risk of postoperative cardiovascular issues

By Neha MathurDec 16 2022Reviewed by Aimee Molineux

In a recent article published in JAMA Network Open, researchers assessed the temporal relationship between COVID-19 diagnosis and surgery time with the risk of occurrence of cardiovascular morbidity events within 30 days of surgery.

Background

The time interval between COVID-19 diagnosis and surgery is a risk factor for postoperative complications but remains unaddressed.

Studies have shown more deaths among surgical patients within six weeks of operation who had a history of COVID-19. Thus, based on the COVID-19 severity and the patient's vaccination status, the Anesthesia Patient Safety Foundation (APSF) and the American Society of Anesthesiologists (ASA) recommend delaying surgery for four to 12 weeks following COVID-19 diagnosis.

More importantly, COVID-19 increases the risk of heart-related disorders (e.g., myocardial injury) and acute kidney injury (AKI) owing to its effects, such as regional hyperinflammation and excessive cytokine release. There is a need to investigate how the time from COVID-19 diagnosis to surgery is associated with the risk of postoperative cardiovascular morbidity.

About the study

The researchers obtained study data from the Structured Query Language access of a perioperative data warehouse in Nashville, Tennessee, United States, for their single-center, retrospective cohort study conducted among 3997 ≥ 18-year-old adults. These adults had a confirmed COVID-19 diagnosis, assessed by reverse-transcription polymerase chain reaction (RT-PCR). They had to undergo surgery between January 1, 2020, and December 6, 2021.

First, the team assessed the combined occurrence of major cardiovascular comorbidities. These encompassed several heart conditions, such as deep vein thrombosis (DVT), cerebrovascular accident, pulmonary embolism (PE), and myocardial injury. The team also assessed, using multivariable logistic regression, the incidence of AKI and death within 30 days of surgery. Lastly, they evaluated variation(s) in these associations based on a patient's COVID-19 vaccination status.

Study findings

The study population comprised 3997 patients, Blacks, White, and other races, with a median age of 51.3 years. The average time between COVID-19 diagnosis and surgery was 98 days. The researchers noted adverse postoperative cardiovascular events in 485, i.e., 12.1% of the patients. Further, they found that increasing the time between COVID-19 diagnosis and surgery decreased the rate of the combined adverse postoperative outcomes, with an adjusted odds ratio of 0.99. It covered all well-established cardiovascular complications, such as DVT, PE, CVA, myocardial injury, AKI, and death within 30 days of surgery.

There is limited evidence suggesting the time to delay surgery post-COVID-19 diagnosis, though seven weeks is the minimum recommended delay time. Yet, it remains unknown how vaccination status or specific viral variants might increase the risk of postoperative complications. Nevertheless, the study provided a more granular overview of the temporal association between COVID-19 and composite adverse outcomes after surgery. It estimated a 1% reduction in the risk of these postoperative adverse outcomes every 10 days after COVID-19 diagnosis.

The observed time-varying correlation between the timing of surgery and postoperative outcomes among asymptomatic patients was statistically insignificant, yet, the study results depicted a trend toward reducing rates of postoperative complications with more time gap between COVID-19 diagnosis and surgery.

Conclusions

The study results established that increasing the time from COVID-19 diagnosis to surgery reduced the odds of postoperative adverse cardiovascular events. This data could inform the risk-benefit debate regarding optimal surgery time and perioperative outcomes in patients with COVID-19. With this data, a surgeon could make more informed decisions about delaying or proceeding with surgery after COVID-19 and better plan overall perioperative risk.

Another smaller observational study found an increased risk of pulmonary complications in surgical patients with asymptomatic COVID-19. The results, however, did not apply to a larger cohort of asymptomatic patients who opted for elective surgeries. Since the overall evidence remains inconclusive, more research is needed to assess the effects of the dynamic management of COVID-19 and newer SARS-CoV-2 variants.