We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study / Prucher, GIAN MARCO; Assenza, Marco; Binda, Barbara; Biondi, Massimo; Brachini, Gioia; Bruzzaniti, Placido; Mauro, Casagrande; Ciccarone, Flavia; Cicerchia, PIERFRANCO MARIA; Cirillo, Bruno; Crocetti, Daniele; D'Ambrosio, Giancarlo; D'Andrea, Vito; DE FELICE, Francesca; DE TOMA, Giorgio; DELLA ROCCA, Carlo; Duranti, Giulia; Familiari, Pietro; Fiori, Enrico; Fonsi, Giovanni Battista; Frati, Alessandro; LA ROCCA, Stefania; LA TORRE, Filippo; Lapolla, Pierfrancesco; Marruzzo, Giovanni; Meneghini, Simona; Mingoli, Andrea; Pata, Francesco; Picchetto, Andrea; Polimeni, Antonella; Ribuffo, Diego; Salvati, Maurizio; Santoro, Antonio; Sapienza, Paolo; Luigi, Simonelli; Valentini, Valentino; Zambon, Martina; Zancana, Giuseppa; Zuppi, Emma; D'Annunzio, Simone; DE NUNZIO, Cosimo; Fiorelli, Silvia; Ibrahim, Mohsen; Loffredo, Chiara; Massullo, Domenico; Menna, Cecilia; Rocco, Monica; Pelli, Massimiliano; Rendina, Erino Angelo; Teodonio, Leonardo; Tubaro, Andrea; Trungu, Sokol; Picotti, Veronica; Gallo, Gaetano; D'Urso, Antonio. - In: ANAESTHESIA. - ISSN 0003-2409. - (2021). [10.1111/anae.15560]
Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
Gian Marco PrucherMembro del Collaboration Group
;Marco Assenza;Barbara Binda;Massimo Biondi;Gioia Brachini;Placido Bruzzaniti;Flavia Ciccarone;Pierfranco Maria Cicerchia;Bruno Cirillo;Daniele Crocetti;Giancarlo D’ambrosio;Vito D’andrea;Francesca De Felice;Giorgio De Toma;Carlo Della Rocca;Giulia Duranti;Pietro Familiari;Enrico Fiori;Giovanni Battista Fonsi;Alessandro Frati;Stefania La Rocca;Filippo La Torre;Pierfrancesco Lapolla;Giovanni Marruzzo;Simona Meneghini;Andrea Mingoli;Francesco Pata;Andrea Picchetto;Antonella Polimeni;Diego Ribuffo;Maurizio Salvati;Antonio Santoro;Paolo Sapienza;Valentino Valentini;Martina Zambon;Giuseppa Zancana;Emma Zuppi;Simone D’Annunzio;Cosimo De Nunzio;Silvia Fiorelli;Mohsen Ibrahim;Chiara Loffredo;Domenico Massullo;Cecilia Menna;Rocco Monica;Massimiliano Pelli;Erino Angelo Rendina;Leonardo Teodonio;Andrea Tubaro;Sokol Trungu;Veronica Picotti;Gaetano Gallo;Antonio D'Urso
2021
Abstract
We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.| File | Dimensione | Formato | |
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