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. 2023 Apr:58:101881.
doi: 10.1016/j.eclinm.2023.101881. Epub 2023 Mar 1.

Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study

Marc Garnier  1   2 , Jean-Michel Constantin  3 , Raphaël Cinotti  4   5 , Chafia Daoui  6 , Dimitri Margetis  3 , Grégory Destruhaut  7 , Cédric Cirenei  8 , Eric Noll  9 , Christophe Quesnel  1 , Agnes Lecinq  10 , Sigismond Lasocki  11 , Hélène Charbonneau  12 , Stanislas Abrard  13 , Cyril Quemeneur  3   14 , Bruno Pastene  15 , Nathanaël Lapidus  16 , Marc Leone  15 ; DROMIS-22 Study Group and the SFAR Research Network
Collaborators, Affiliations

Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study

Marc Garnier et al. EClinicalMedicine. 2023 Apr.

Abstract

Background: Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity.

Methods: We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting.

Findings: Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48-2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02-15.8]; p = 0.04).

Interpretation: In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity.

Funding: The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).

Keywords: Acute respiratory failure; Anaesthesia; COVID-19; Perioperative risk; Postoperative pneumonia; Prognosis; Respiratory complications; Surgery.

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Conflict of interest statement

M.G. declares past honoraria from Medtronic France SAS for a presentation on the topic of surgery postponement in the case of preoperative COVID-19. All the other authors declare that they do not have any conflict of interest related to this work.

Figures

Fig. 1
Fig. 1
Flow chart for cohort recruitment including details on inclusion and non-inclusion criteria.
Fig. 2
Fig. 2
Raw incidence of the respiratory morbidity outcome depending on the time between preoperative COVID-19 and surgery. Histograms represent the raw incidence and error bars the 95% confidence interval of the proportion.
See this image and copyright information in PMC

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