6533b837fe1ef96bd12a323d

RESEARCH PRODUCT

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

Dmitri NepogodievJoana Ff SimoesElizabeth LiMaria PicciochiJames C GlasbeyGlauco BaiocchiRuth Blanco-colinoDaoud ChaudhryEhab AlameerKariem El-boghdadlyFunmilola WuraolaDhruva GhoshRohan R GujjuriEwen M HarrisonHerman LuleHaytham KaafaraniMohammad KhosraviIrmgard KronbergerSezai LeventoğluHarvinder MannKenneth A McleanMengistu Gebreyohanes MengeshaMaria Marta ModoloFaustin NtirenganyaLisa NormanOumaima OutaniRiinu PiusPeter PockneyAhmad Uzair QureshiApril Camilla RoslaniSohei SatoiCatherine ShawAneel BhanguDmitri NepogodievOmar M OmarWaheed-ul-rahman AhmedLeah ArgusAlasdair BallAneel BhanguEdward P BywaterRuth Blanco-colinoAmanpreet BrarDaoud ChaudhryBrett E DawsonIrani DuranMuhammed ElhadiJames C GlasbeyRohan R GujjuriConor S JonesEwen M HarrisonSivesh K KamarajahJames M KeatleySamuel LawdayElizabeth LiHarvinder MannElla J MarsonKenneth A McleanDmitri NepogodievLisa NormanRiinu OtsOumaima OutaniMaria PicciochiIrène SantosCatherine ShawJoana Ff SimoesElliott H TaylorIsobel M TroutChris VargheseMary L VennWilliam XuJoana Ff SimoesIrida DajtiArben GjataSalah Eddine Oussama KacimiLuis BoccalatteMaria Marta ModoloDaniel CoxPeter PockneyPhilip TownendFelix AignerIrmgard Elisabeth KronbergerElgun SamadovAmer AlderaziKamral HossainGreg PadmoreGabrielle Van RamshorstIsmaïl LawaniAnis CerovacSamir DelibegovicGlauco BaiocchiGustavo Mendonça Ataíde GomesIgor Lima BuarqueMuhammad GoharMihail T SlavchevChukwuemeka NwegbuArnav AgarwalAmanpreet BrarJanet MartinJoshua Ng-kamstraMaria Marta ModoloMaricarmen OlivosWenhui LouDong-lin RenJose Andres CalvacheCarlos J Perez RiveraAna Danic HadzibegovicTomislav KopjarJakov MihanovicPablo Mijahil Avilés JiménezNikolaos GouvasJaroslav KlatRené NovysedlákNicolas AmisiPeter ChristensenAlaa El-hussunaSylvia BatistaEddy Lincango-naranjoSameh EmileDanilo Alfonso Arévalo SandovalHailu DhuferaSamuel HailuMengistu G MengeshaJoonas H KauppilaAlexis P ArnaudZaza DemetrashviliMarkus AlbertsmeierHans LederhuberMarkus W LöfflerDaniel Kwesi AcquahBernard 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TaboadaSebastian TirapeguiConstanza UffelmannCarlos VaccaroRoberto VagniAna Clara ValerioCeleste Soledad ZarrateaCarina ChwatSilvina MontalBrian MorrisPedro ValdezFernando Diaz-couseloRicci CCasadei R

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Lung DiseasesMaleInternationalitySARS-Cov-2 ; COVID-19 ; surgery ; pathways ; pre-operative isolationSettore MED/18 - CHIRURGIA GENERALEVascular damage Radboud Institute for Health Sciences [Radboudumc 16]pathwaysLung DiseaseESTUDOS PROSPECTIVOSCohort StudiesPatient IsolationsurgeryPostoperative Complications80 and overProspective StudiesProspective cohort study610 Medicine & healthAged 80 and overSARS-Cov-2; COVID-19; surgery; pathways; pre-operative isolationIncidence (epidemiology)Treatment OutcomeElective Surgical ProceduresFemaleElective Surgical ProcedureCohort studyHumanpre-operative isolationmedicine.medical_specialtyIsolation (health care)SARS-Cov-2Preoperative careNOCOVID-19; SARS-Cov-2; pathways; pre-operative isolation; surgeryAnesthesiologyPreoperative CaremedicineHumansElective surgeryLS7_4AgedElective Surgical Procedurebusiness.industrypathwayCOVID-19SurgeryReconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10]Prospective StudieAnesthesiology and Pain MedicineHuman medicinePostoperative ComplicationCohort Studiebusiness[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

description

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. 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.

yearjournalcountryeditionlanguage
2021-11-01
10.1111/anae.15560https://hal.science/hal-04058596