Prior COVID-19 Infection and Risk of Death After Noncardiac Procedures

Prior SARS-CoV-2 infection is not associated with increased risk for death, major adverse cardiovascular (CV) events, or rehospitalization following elective, major, noncardiac procedures, according to the results published in JAMA Open Network.

Recognizing that an urgent need exists for evidence to inform presurgical risk assessment for millions of individuals who have  experienced a SARS-CoV-2 infection and await an elective procedure, researchers sought to evaluate the association of previous COVID-19 infection with death, major adverse CV events, and rehospitalization following elective, major, noncardiac procedures. They conducted a population-based cohort study in Ontario, Canada, from April 2020 through October 2021

All of the participants in the analysis were aged 18 years or older and had received a polymerase chain reaction test for a SARS-CoV-2 infection within 6 months prior to their elective procedure, with 30 days of follow-up. The main study outcome was the composite of death, major CV events, and all-cause rehospitalization within 30 days following a procedure.

The 6-month exposure period was intentionally selected based on emerging data on the long-term effects of COVID-19 infection. The investigators performed 2 additional analyses. The sample was stratified by patients with either a SARS-CoV-2 infection for less than 4 weeks or less than 7 weeks prior to their procedure, according to findings from a prior analysis that showed adverse outcomes were most often reported within these windows of time. The index date was the day that the procedure was performed.

A total of 71,144 patients received an elective, major, noncardiac procedure during the study, with 1.3% of them having had a positive PCR test result for SARS-CoV-2 and 98.7% of them having had a negative PCR test result in the 6 months prior to their procedure. Overall, 59.8% of the patients were women and 40.2% were men. The median participant age was 66 years (IQR, 57-73 years).

Results of the study showed that the overall composite outcome of death, major adverse CV events, and all-cause hospitalization within 30 days of the procedure was reported in 5.3% of the study cohort. Following adjustment, history of SARS-CoV-2 infection was not associated with the composite risk for death, major adverse CV events, and all-cause rehospitalization within 30 days of an elective, major, noncardiac procedure (adjusted relative risk [aRR], 0.91; 95% CI, 0.68-0.21) or with any of the individual components of the composite primary outcome.

Further, no association was observed between a prior COVID-19 infection and postoperative outcomes when the time between the infection and the procedure was less than 4 weeks (aRR, 1.15; 95% CI, 0.64-2.09) or less than 7 weeks (aRR, 0.95; 95% CI, 0.56-1.61), nor among those participants who were previously vaccinated (aRR, 0.81; 95% CI, 0.52-1.26).

Some limitations of the study include that not all individuals with a symptomatic SARS-CoV-2 infection are known seek medical treatment or testing to confirm the presence of an infection, particularly those whose symptoms are mild. Additionally, the investigators lack data regarding patients’ symptoms. Previous research has suggested that individuals who remain symptomatic following up to a 7-week delay, including those who have active disease such as pneumonia, continue to experience increased postsurgical risk.

“These findings may have direct applications to health resource planning and utilization as jurisdictions emerge from the pandemic and address massive backlogs in elective surgeries.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

This article originally appeared on The Cardiology Advisor