• Nathaniel B Verhagen, Gopika SenthilKumar, Taylor Jaraczewski, Nicolas K Koerber, Jennifer R Merrill, Madelyn A Flitcroft, Aniko Szabo, Anjishnu Banerjee, Xin Yang, Bradley W Taylor, Carlos E Figueroa Castro, YenTina W FTWFDepartment of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI., Callisia N Clarke, Kathryn Lauer, Kurt J Pfeifer, Jon C Gould, Anai N Kothari, and N3C Consortium.
• Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI.
• Ann. Surg. 2023 Nov 1; 278 (5): e949e956e949-e956.

ObjectiveTo determine how the severity of prior history (Hx) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection influences postoperative outcomes after major elective inpatient surgery.BackgroundSurgical guidelines instituted early in the coronavirus disease 2019 (COVID-19) pandemic recommended a delay in surgery of up to 8 weeks after an acute SARS-CoV-2 infection. This was based on the observation of elevated surgical risk after recovery from COVID-19 early in the pandemic. As the pandemic shifts to an endemic phase, it is unclear whether this association remains, especially for those recovering from asymptomatic or mildly symptomatic COVID-19.MethodsUtilizing the National COVID Cohort Collaborative, we assessed postoperative outcomes for adults with and without a Hx of COVID-19 who underwent major elective inpatient surgery between January 2020 and February 2023. COVID-19 severity and time from infection to surgery were each used as independent variables in multivariable logistic regression models.ResultsThis study included 387,030 patients, of whom 37,354 (9.7%) were diagnosed with preoperative COVID-19. Hx of COVID-19 was found to be an independent risk factor for adverse postoperative outcomes even after a 12-week delay for patients with moderate and severe SARS-CoV-2 infection. Patients with mild COVID-19 did not have an increased risk of adverse postoperative outcomes at any time point. Vaccination decreased the odds of respiratory failure.ConclusionsImpact of COVID-19 on postoperative outcomes is dependent on the severity of illness, with only moderate and severe disease leading to a higher risk of adverse outcomes. Existing perioperative policies should be updated to include consideration of COVID-19 disease severity and vaccination status.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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