TY - JOUR

T1 - Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery

T2 - an international prospective cohort study

AU - COVIDSurg Collaborative

AU - GlobalSurg Collaborative

AU - Трофимов, Алексей Андреевич

AU - Золотухо, Анна Викторовна

N1 - Publisher Copyright: © 2021 Association of Anaesthetists.

PY - 2021/11

Y1 - 2021/11

N2 - We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

AB - We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

KW - COVID-19

KW - pathways

KW - pre-operative isolation

KW - SARS-Cov-2

KW - surgery

KW - Prospective Studies

KW - Humans

KW - Male

KW - Treatment Outcome

KW - COVID-19/epidemiology

KW - Internationality

KW - Patient Isolation/trends

KW - Aged, 80 and over

KW - Female

KW - Aged

KW - Preoperative Care/adverse effects

KW - Elective Surgical Procedures/adverse effects

KW - Postoperative Complications/diagnosis

KW - Lung Diseases/diagnosis

KW - Cohort Studies

UR - http://www.scopus.com/inward/record.url?scp=85115093179&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/4a705e02-1371-3104-bb37-f969cb70e97a/

U2 - 10.1111/anae.15560

DO - 10.1111/anae.15560

M3 - Article

C2 - 34371522

AN - SCOPUS:85115093179

VL - 76

SP - 1454

EP - 1464

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 11

ER -