术前新型冠状病毒肺炎与择期非心脏手术后死亡率、呼吸系统并发症和肺外并发症的关系：一项观察性队列研究。
Association of preoperative coronavirus disease 2019 with mortality, respiratory morbidity and extrapulmonary complications after elective, noncardiac surgery: An observational cohort study.
机构信息
Department of Anesthesiology, Huashan Hospital of Fudan University, Shanghai, China.
Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA.
出版信息
J Clin Anesth. 2024 Aug;95:111467. doi: 10.1016/j.jclinane.2024.111467. Epub 2024 Apr 8.
STUDY OBJECTIVE
To 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.
DESIGN
An ambidirectional observational cohort study.
SETTING
A tertiary and teaching hospital in Shanghai, China.
PATIENTS
All 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.
EXPOSURE
Preoperative coronavirus disease 2019 (COVID-19) positivity.
MEASUREMENTS
The 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 RESULTS
The 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).
CONCLUSIONS
Preoperative 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.
研究目的
评估术前感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的当代株对择期非心脏手术后 30 天内死亡率、呼吸系统发病率和肺外并发症的影响。
设计
双向观察性队列研究。
设置
中国上海华山医院的一家三级教学医院。
患者
从 2023 年 1 月至 3 月，在复旦大学华山医院接受全身麻醉下择期非心脏手术的所有成年患者（≥18 岁）均进行了入选资格筛查。共纳入 2907 例患者。
暴露
术前新冠病毒病 2019（COVID-19）阳性。
测量
主要结局为术后 30 天内死亡率。次要结局包括术后肺部并发症（PPCs）、非心脏手术后心肌损伤（MINS）、急性肾损伤（AKI）、术后谵妄（POD）和术后睡眠质量。多变量逻辑回归用于评估术前 COVID-19 对术后死亡率和发病率的风险。
主要结果
30 天术后死亡率与术前 COVID-19 无关[校正优势比（aOR），95%置信区间（CI）：0.40，0.13-1.28，P=0.123]或手术时机与诊断的关系。术前 COVID-19 并未增加 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）或 AKI（aOR，95%CI：0.34，0.10-1.09；P=0.070）的风险，也不会影响术后睡眠质量。COVID-19 后 7 周内接受手术的患者发生谵妄的几率增加（aOR，95%CI：2.26，1.05-4.86，P=0.036）。
结论
术前 COVID-19 或手术时机与诊断的关系并未增加 30 天术后死亡率、PPCs、MINS 或 AKI 的风险。然而，近期 COVID-19 增加了 POD 的风险。在对 COVID-19 幸存者进行术前风险评估时，应考虑围手术期大脑健康。
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