Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
Summary 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. Isolati...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English English English English |
| Published: |
Wiley-Blackwell
2021
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| Online Access: | http://irep.iium.edu.my/93278/7/93278_Effects%20of%20pre-operative%20isolation_SCOPUS.pdf http://irep.iium.edu.my/93278/8/93278_Effects%20of%20pre-operative%20isolation.pdf http://irep.iium.edu.my/93278/9/Appendix%20S1.pdf http://irep.iium.edu.my/93278/25/93278_Effects%20of%20pre-operative%20isolation_WoS.pdf http://irep.iium.edu.my/93278/ https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15560#anae15560-sup-0003 https://doi.org/10.1111/anae.15560 |
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| Summary: | Summary
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.
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