The Perfect Enemy | COVID infection within 60 days not tied to adverse postsurgical outcomes
April 11, 2024

COVID infection within 60 days not tied to adverse postsurgical outcomes

The latest evidence suggests clinical expertise, rather than a fixed time interval, should guide decisions on proceeding with surgery in recovered COVID patients.

COVID-19 infection within the previous 60 days was not tied to a risk of adverse postsurgical outcomes, regardless of timing, according to a study of more than 29,000 US veterans published today in JAMA Network Open.

Veterans Affairs Boston researchers studied rates of adverse postoperative events among 29,093 veterans undergoing major surgery at 1 of 123 hospitals from January 1 to September 30, 2021, a period dominated by the Alpha and Delta SARS-CoV-2 strains.

All participants were encouraged to be vaccinated against COVID-19 and were tested for infection before surgery using reverse transcription-polymerase chain reaction (RT-PCR). The average patient age was 66.1 years, 90.0% were men, and 67.5% were White. Of the 15,553 surgeries performed, 53.5% were for hospitalized patients, who had an average stay of 5.0 days. The average time from infection to surgery was 30 days.

Adverse postoperative events were considered death, cardiac events, central nervous system or respiratory dysfunction, surgical infection, or blood clots within 30 days after surgery.

Surgery timing ‘should be based on clinical expertise’

Among the 28,635 patients without COVID-19 infection in the previous 60 days, 4.7% had an adverse postsurgical complication, compared with 7.6% of the 238 patients infected within the previous 30 days and 3.2% of the 220 infected within 60 days.

The odds ratios (ORs) for adverse postsurgical outcomes were 1.40 among those infected within 30 days and 0.68 among the 60-day infection group.

“These findings suggest that recent COVID-19 infection was not associated with risk of adverse postoperative outcomes, regardless of timing within the previous 60 days,” the study authors wrote.

The researchers noted the results of two recent studies, one finding that surgery within 2 months after a COVID-19 diagnosis was tied to a higher 90-day death rate relative to matched controls, and the other showing lower perioperative risk for vaccinated surgical patients and unvaccinated patients who didn’t receive general anesthesia.

“These studies may shift the timing of surgery relative to recent infection,” they wrote. “Our study further rebalances the scale in favor of performing surgery in recently recovered patients.”

The strengths of their study were that it was based on a national surgical registry and reliable evaluation of vaccination and infection rates, they said.

While the target trial design was chosen to lower the rate of certain biases, the authors said the results may still be biased due to unmeasured covariables and selection bias related to patients who didn’t have surgery because of their clinical condition.

“Nevertheless, current evidence suggests the decision to proceed should be based on clinical expertise rather than a fixed time interval after infection, consistent with current guidelines,” they concluded.