Department of Surgery, State University of New York Downstate Health Sciences University, Brooklyn, NY.
Operative Care Line/Research Service Line, New York Harbor VA Health Care System, Brooklyn, NY.
Ann Surg. 2024 Jan 1;279(1):58-64. doi: 10.1097/SLA.0000000000006051. Epub 2023 Jul 27.
The objective of this study was to compare postoperative 90-day mortality between (1) fully vaccinated patients with COVID-19-positive and negative diagnosis, and (2) vaccinated and unvaccinated patients with COVID-19 positive diagnosis.
Societal guidelines recommend postponing elective operations for at least 7 weeks in unvaccinated patients with preoperative coronavirus disease 2019 (COVID-19) infection. The role of vaccination in this infection-operation time risk is unclear.
We conducted a national US multicenter retrospective, matched cohort study spanning July 2021 to October 2022. Participants were included if they underwent a high-risk general, vascular, orthopedic, neurosurgery, or genitourinary surgery. All-cause mortality occurring within 90 days of the index operation was the primary outcome. Inverse probability treatment weighted propensity scores were used to adjust logistic regression models examining the independent and interactive associations between mortality, exposure status, and infection proximity.
Of 3401 fully vaccinated patients in the 8-week preoperative period, 437 (12.9%) were COVID-19-positive. Unadjusted mortality rates were not significantly different between vaccinated patients with COVID-19 (22, 5.0%) and vaccinated patients without COVID-19 (99, 3.3%; P = 0.07). After inverse probability treatment weighted adjustment, mortality risk was not significantly different between vaccinated COVID-19-positive patients compared to vaccinated patients without COVID-19 (adjusted odds ratio = 1.38, 95% CI: 0.70, 2.72). The proximity of COVID-19 diagnosis to the index operation did not confer added mortality risk in either comparison cohort.
Contrary to risks observed among unvaccinated patients, postoperative mortality does not differ between patients with and without COVID-19 when vaccinated against the severe acute respiratory syndrome coronavirus 2 virus and receiving a high-risk operation within 8 weeks of the diagnosis, regardless of operation timing relative to diagnosis.
本研究旨在比较（1）COVID-19 检测结果阳性和阴性的完全接种患者与（2）COVID-19 检测结果阳性的接种和未接种患者的术后 90 天死亡率。
社会指南建议，对于术前患有 2019 年冠状病毒病（COVID-19）感染的未接种患者，至少推迟 7 周进行择期手术。接种疫苗在这种感染-手术时间风险中的作用尚不清楚。
我们进行了一项全国性美国多中心回顾性、匹配队列研究，时间跨度为 2021 年 7 月至 2022 年 10 月。如果患者接受高风险的普通外科、血管外科、骨科、神经外科或泌尿生殖器手术，则纳入研究。主要结局为指数手术后 90 天内的全因死亡率。采用逆概率治疗加权倾向评分调整逻辑回归模型，以评估死亡率、暴露状态和感染接近程度之间的独立和交互关联。
在 8 周术前期间的 3401 名完全接种疫苗的患者中，有 437 名（12.9%）COVID-19 检测结果呈阳性。未调整的死亡率在接种 COVID-19 疫苗的患者（22 例，5.0%）和未接种 COVID-19 疫苗的患者（99 例，3.3%；P=0.07）之间没有显著差异。经过逆概率治疗加权调整后，接种 COVID-19 阳性患者的死亡风险与未接种 COVID-19 患者相比没有显著差异（调整后的优势比=1.38，95%CI：0.70，2.72）。COVID-19 诊断与指数手术的接近程度在任何比较队列中均未增加死亡风险。
与未接种疫苗患者观察到的风险相反，当接种严重急性呼吸系统综合征冠状病毒 2 病毒疫苗并在 COVID-19 诊断后 8 周内接受高危手术时，无论手术时间相对于诊断时间如何，有 COVID-19 感染和无 COVID-19 感染的患者之间的术后死亡率没有差异。
