Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
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Date
2021-07-14
Journal Title
Journal ISSN
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Publisher
Association of Anaesthestetics Great Britain and Ireland.
Abstract
Weaimedtodeterminetheimpactofpre-operativeisolationonpostoperativepulmonarycomplicationsafter
electivesurgeryduringtheglobalSARS-CoV-2pandemic.Weperformedaninternationalprospectivecohort
study includingpatientsundergoingelectivesurgery inOctober2020. Isolationwasdefinedastheperiod
beforesurgeryduringwhichpatientsdidnotleavetheirhouseorreceivevisitorsfromoutsidetheirhousehold.
Theprimaryoutcomewaspostoperativepulmonary complications, adjusted inmultivariablemodels for
measuredconfounders.Pre-definedsub-groupanalyseswereperformedfortheprimaryoutcome.Atotalof
96,454patientsfrom114countrieswereincludedandoverall,26,948(27.9%)patientsisolatedbeforesurgery.
Postoperativepulmonarycomplicationswererecordedin1947(2.0%)patientsofwhich227(11.7%)were
associatedwithSARS-CoV-2infection.Patientswhoisolatedpre-operativelywereolder,hadmorerespiratory
comorbiditiesandweremorecommonlyfromareasofhighSARS-CoV-2incidenceandhigh-incomecountries.
Althoughtheoverall ratesofpostoperativepulmonarycomplicationsweresimilar inthosethat isolatedand
thosethatdidnot (2.1%vs2.0%, respectively), isolationwasassociatedwithhigher ratesofpostoperative
pulmonarycomplicationsafteradjustment(adjustedOR1.20,95%CI1.05–1.36,p=0.005).Sensitivityanalyses
revealednofurtherdifferenceswhenpatientswerecategorisedby:pre-operativetesting;useofCOVID-19-free
pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications
increasedwithperiodsofisolationlongerthan3days,withanOR(95%CI)at4–7daysor≥8daysof1.25(1.04
1.48), p=0.015and1.31 (1.11–1.55), p=0.001, respectively. Isolationbeforeelectivesurgerymightbe
associatedwithasmall but clinically important increasedriskof postoperativepulmonarycomplications.
Longerperiodsofisolationshowednoreductionintheriskofpostoperativepulmonarycomplications.These
findingshavesignificantimplicationsforglobalprovisionofelectivesurgicalcare.
Description
Keywords
SARS-Cov-2, COVID-19, surgery, pathways, pre-operativeisolation