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.

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

Andrea Porta
Membro del Collaboration Group
;
Domenico Lacavalla
Membro del Collaboration Group
;
Savino Occhionorelli
Membro del Collaboration Group
;
Michele Rubbini
Membro del Collaboration Group
;
Nicolò Fabbri
Membro del Collaboration Group
;
Marta Fazzin
Membro del Collaboration Group
;
Carlo V Feo
Membro del Collaboration Group
;
Marco Torchiaro
Membro del Collaboration Group
;
Chiara Bruno
Membro del Collaboration Group
;
Angeli Christy Yu
Membro del Collaboration Group
2021

Abstract

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.
Simoes, ; Dmitri Nepogodiev, J; Ff Simoes, Joana; Li, Elizabeth; Picciochi, Maria; C Glasbey, James; Baiocchi, Glauco; Blanco-Colino, Ruth; Chaudhry, Daoud; Alameer, Ehab; El-Boghdadly, Kariem; Wuraola, Funmilola; Ghosh, Dhruva; R Gujjuri, Rohan; M Harrison, Ewen; Lule, Herman; Kaafarani, Haytham; Khosravi, Mohammad; Kronberger, Irmgard; Leventoğlu, Sezai; Mann, Harvinder; A Mclean, Kenneth; Gebreyohanes Mengesha, Mengistu; Marta Modolo, Maria; Ntirenganya, Faustin; Norman, Lisa; Outani, Oumaima; Pius, Riinu; Pockney, Peter; Uzair Qureshi, Ahmad; Camilla Roslani, April; Satoi, Sohei; Shaw, Catherine; Bhangu, Aneel; Nepogodiev, Dmitri; Omar, M Omar; Ahmed, Waheed-Ul-Rahman; Argus, Leah; Ball, Alasdair; Bhangu, Aneel; P Bywater, Edward; Blanco-Colino, Ruth; Brar, Amanpreet; Chaudhry, Daoud; E Dawson, Brett; Duran, Irani; Elhadi, Muhammed; C Glasbey, James; R Gujjuri, Rohan; S Jones, Conor; M Harrison, Ewen; K Kamarajah, Sivesh; M Keatley, James; Lawday, Samuel; Li, Elizabeth; Mann, Harvinder; J Marson, Ella; A Mclean, Kenneth; Nepogodiev, Dmitri; Norman, Lisa; Ots, Riinu; Outani, Oumaima; Picciochi, Maria; Santos, Irène; Shaw, Catherine; Ff Simoes, Joana; H Taylor, Elliott; M Trout, Isobel; Varghese, Chris; L Venn, Mary; Xu, William; Ff Simoes, Joana; Dajti, Irida; Gjata, Arben; Eddine Oussama Kacimi, Salah; Boccalatte, Luis; Marta Modolo, Maria; Cox, Daniel; Pockney, Peter; Townend, Philip; Aigner, Felix; Elisabeth Kronberger, Irmgard; Samadov, Elgun; Alderazi, Amer; Hossain, Kamral; Padmore, Greg; van Ramshorst, Gabrielle; Lawani, Ismaïl; Cerovac, Anis; Delibegovic, Samir; Baiocchi, Glauco; Mendonça Ataíde Gomes, Gustavo; Lima Buarque, Igor; Gohar, Muhammad; Slavchev, Mihail; Nwegbu, Chukwuemeka; Agarwal, Arnav; Brar, Amanpreet; Martin, Janet; Ng-Kamstra, Joshua; Marta Modolo, Maria; Olivos, Maricarmen; Lou, Wenhui; Maqsood, Fauzia; Almoosa, Noora; Naseer, Mai; Shadrul Alam, Mohammed; Khairul Basher, Akm; Islam, Shahnoor; M Nazmul Islam, S; Karim, Sabbir; Faisel, Muntasir; Khan, Sadia; Ibne Mannan, Iftekhar; Nazia, Nawshin; Bentham, Malissa; Corbin, Sasha; Doyle, Alex; Eastmond, Asha; Haynes, Amelia; O'Shea, Margaret; Padmore, Greg; Phillips, Emil; Walkes, Keisha; L Artyushkov, Evgeniy; L Kaplan, Mark; Straltsov, Vladislav; Litvina, Yauheniya; Lyzikov, Alexei; E Tihmanovich, Victor; Borges, Mafalda; Brits, Tim; De Hous, Nicolas; De Wachter, Stefan; Soares Da Silva Menezes, Agna; Araujo, Marcelo; Brito, Kattiucy; Marcelle Lira Albuquerque, Josie; Alberto Dussan-Sarria, Jairo; Souza, Andressa; Ricardo Stüker, Andre; Bresciani, Tiago; Cadore Stefani, Luciana; Totti Cavazzola, Leandro; Costa, Tainá; Dasqueve, Matheus; De Bacco Marangon, Gustavo; Ritter Silveira Martins, Otávio; Rodrigues, Josy; Roloff Cardoso, Guilherme; Silva Neto, Brasil; Soares, Tilaê; Zanella, Aline; Torelly Filippi, Lucas; Eloena Guerra, Enilde; Pedrini Cruz, Ricardo; Nocchi Kalil, Antonio; Laporte, Gustavo; Salem, Moacyr; de Lima Brazan, Murilo; Antonio de Campos Prado, Caio; Christine Dantas Moises, Elaine; Satie Suto, Hilda; Gadotti Yasuda, Alice; Carolina Tagliatti Zani, Ana; Sherif Morsy, Mohamed; Naieem, Mohmed; Nasreddin, Mohammed; Salman, Samar; Sarsik, Sameh; Shabana, Ahmed; Tolba, Engy; Zagho, Mohamed; Alfonso Arévalo Sandoval, Danilo; Kams, Liisa; Rätsep, Tõnu; Riips, Karolin; Abdurehman, Oumer; Admasu, Azarias; Berhea, Ataklitie; Eado, Yegeremu; Hailu, Nebiyou; Kidane, Meklit; Mohammed, Abdurezak; Mohammed, Khalid; Negussie, Abraham; Koslowski, Lisa; Krause, Hardy; Meyer, Frank; Rissmann, Anke; Turial, Salmai; Al-Nawas, Bilal; Johannes Battista, Marco; Goedeke, Jan; Hasenburg, Annette; Heider, Julia; Catherine Linz, Valerie; Katharina Mueller, Lena; Zeller, Simon; Louisa Patrizia Jentschura, Sina; Kowalewski, Karl-Friedrich; Kriegmair, Maximilian; Männle, David; Rahbari, Nuh; Rassweiler-Seyfried, Marie-Claire; Reissfelder, Christoph; Rotter, Nicole; Scherl, Claudia; Seyfried, Steffen; Kirschniak, Andreas; Rolinger, Jens; Wilhelm, Peter; G Bader, Franz; Eleonora Gut, Anna; Ottl, Stephanie; Monti, Eleonora; LA PORTA, Andrea; Sambucci, Daniele; Birindelli, Arianna; Carrara, Barbara; Compagnoni, Bruno; Del Giudice, Roberto; Elisabetta Dester, Sara; Lomiento, Daniele; Ruggiero, Silvia; Taglietti, Lucio; Viotti, Fabio; Lacavalla, Domenico; Occhionorelli, Savino; Rubbini, Michele; Bernabei, Massimiliano; Fabbri, Nicolò; Fazzin, Marta; Feo, Carlo; Torchiaro, Marco; Costi, Renato; Virgilio, Edoardo; Arlia, Lorenzo; Barbato, Giuseppe; Bartolini, Ilenia; Bottari, Andrea; Bruno, Iliane Chiara; Bruscino, Alessandro; Checcucci, Carlotta; Cianchi, Fabio; Coratti, Francesco; Yu, ANGELI CHRISTY
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