Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
CITADEL, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
BMJ Open. 2024 Nov 21;14(11):e090158. doi: 10.1136/bmjopen-2024-090158.
Our primary objective was to assess the association between symptoms at the time of surgery and postoperative pulmonary complications and mortality in patients with COVID-19. Our secondary objective was to compare postoperative outcomes between patients who had recovered from COVID-19 and asymptomatic patients and explore the effect of the time elapsed between infection and surgery in the former. Our hypotheses were that symptomatic patients had a higher risk of pulmonary complications, whereas patients who had recovered from the infection would exhibit outcomes similar to those of asymptomatic patients.
Managing COVID-19-positive patients requiring surgery is complex due to perceived heightened perioperative risks. However, Canadian data in this context remains scarce.
To address this gap, we conducted a multicentre observational cohort study.
Across seven hospitals in the province of Québec, the Canadian province was most affected during the initial waves of the pandemic.
We included adult surgical patients with either active COVID-19 at the time of surgery or those who had recovered from the disease, from March 22, 2020 to April 30, 2021.
We evaluated the association between symptoms or recovery time and postoperative pulmonary complications and hospital mortality using multivariable logistic regression and Cox models. The primary outcome was a composite of any postoperative pulmonary complication (atelectasis, pneumonia, acute respiratory distress syndrome and pneumothorax). Our secondary outcome was hospital mortality, assessed from the date of surgery up to hospital discharge.
We included 105 patients with an active infection (47 were symptomatic and 58 were asymptomatic) at the time of surgery and 206 who had recovered from COVID-19 prior to surgery in seven hospitals. Among patients with an active infection, those who were symptomatic had a higher risk of pulmonary complications (OR 3.19, 95% CI 1.12 to 9.68, p=0.03) and hospital mortality (HR 3.67, 95% CI 1.19 to 11.32, p=0.02). We did not observe any significant effect of the duration of recovery prior to surgery on patients who had recovered from their infection. Their postoperative outcomes were also similar to those observed in asymptomatic patients.
Symptomatic status should be considered in the decision to proceed with surgery in COVID-19-positive patients. Our results may help optimise surgical care in this patient population.
ClinicalTrials.gov Identifier: NCT04458337 registration date: 7 July 2020.
我们的主要目的是评估 COVID-19 患者手术时的症状与术后肺部并发症和死亡率之间的关系。我们的次要目的是比较 COVID-19 已康复患者与无症状患者的术后结果，并探讨前者中感染与手术之间时间间隔的影响。我们的假设是，有症状的患者发生肺部并发症的风险更高，而从感染中康复的患者的结果将与无症状患者相似。
由于手术期间的围手术期风险较高，管理需要手术的 COVID-19 阳性患者是复杂的。然而，加拿大在这方面的数据仍然很少。
为了弥补这一空白，我们进行了一项多中心观察性队列研究。
在魁北克省的七家医院，该省在大流行的最初几波中受到的影响最大。
我们纳入了 2020 年 3 月 22 日至 2021 年 4 月 30 日期间手术时患有活动性 COVID-19 或已从疾病中康复的成年外科患者。
我们使用多变量逻辑回归和 Cox 模型评估了症状或恢复时间与术后肺部并发症和医院死亡率之间的关系。主要结局是任何术后肺部并发症（肺不张、肺炎、急性呼吸窘迫综合征和气胸）的综合指标。我们的次要结局是从手术日期到出院的医院死亡率。
在手术时患有活动性感染的 105 例患者（47 例有症状，58 例无症状）和 206 例在手术前已从 COVID-19 中康复的患者中，在七家医院进行了研究。在患有活动性感染的患者中，有症状的患者发生肺部并发症（OR 3.19，95%CI 1.12 至 9.68，p=0.03）和医院死亡率（HR 3.67，95%CI 1.19 至 11.32，p=0.02）的风险更高。我们没有观察到手术前康复时间对已康复患者的任何显著影响。他们的术后结果也与无症状患者观察到的结果相似。
在 COVID-19 阳性患者中决定进行手术时，应考虑症状状态。我们的结果可能有助于优化该患者群体的手术护理。
ClinicalTrials.gov 标识符：NCT04458337 注册日期：2020 年 7 月 7 日。
