• Yi-Heng Liu, Chenghong Hu, Xia-Min Yang, Yu Zhang, Yan-Ling Cao, Fan Xiao, Jun-Jie Zhang, Li-Qing Ma, Zi-Wen Zhou, Si-Yu Hou, E Wang, Andreas W Loepke, and Meng Deng.
• Department of Anesthesiology, Huashan Hospital of Fudan University, Shanghai, China.
• J Clin Anesth. 2024 Aug 1; 95: 111467111467.

Study ObjectiveTo assess the impact of preoperative infection with the contemporary strain of severe acute respiratory coronavirus 2 (SARS-CoV-2) on postoperative mortality, respiratory morbidity and extrapulmonary complications after elective, noncardiac surgery.DesignAn ambidirectional observational cohort study.SettingA tertiary and teaching hospital in Shanghai, China.PatientsAll adult patients (≥ 18 years of age) who underwent elective, noncardiac surgery under general anesthesia at Huashan Hospital of Fudan University from January until March 2023 were screened for eligibility. A total of 2907 patients were included.ExposurePreoperative coronavirus disease 2019 (COVID-19) positivity.MeasurementsThe primary outcome was 30-day postoperative mortality. The secondary outcomes included postoperative pulmonary complications (PPCs), myocardial injury after noncardiac surgery (MINS), acute kidney injury (AKI), postoperative delirium (POD) and postoperative sleep quality. Multivariable logistic regression was used to assess the risk of postoperative mortality and morbidity imposed by preoperative COVID-19.Main ResultsThe risk of 30-day postoperative mortality was not associated with preoperative COVID-19 [adjusted odds ratio (aOR), 95% confidence interval (CI): 0.40, 0.13-1.28, P = 0.123] or operation timing relative to diagnosis. Preoperative COVID-19 did not increase the risk of PPCs (aOR, 95% CI: 0.99, 0.71-1.38, P = 0.944), MINS (aOR, 95% CI: 0.54, 0.22-1.30; P = 0.168), or AKI (aOR, 95% CI: 0.34, 0.10-1.09; P = 0.070) or affect postoperative sleep quality. Patients who underwent surgery within 7 weeks after COVID-19 had increased odds of developing delirium (aOR, 95% CI: 2.26, 1.05-4.86, P = 0.036).ConclusionsPreoperative COVID-19 or timing of surgery relative to diagnosis did not confer any added risk of 30-day postoperative mortality, PPCs, MINS or AKI. However, recent COVID-19 increased the risk of POD. Perioperative brain health should be considered during preoperative risk assessment for COVID-19 survivors.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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