Risk of Early Postoperative Cardiovascular and Cerebrovascular Complication in Patients with Preoperative COVID-19 Undergoing Cancer Surgery

Abstract

Background: As the COVID-19 pandemic shifts to an endemic phase, an increasing proportion of patients with cancer and a preoperative history of COVID-19 will require surgery. This study aimed to assess the influence of preoperative COVID-19 on postoperative risk for major adverse cardiovascular and cerebrovascular events (MACEs) among those undergoing surgical cancer resection. Secondary objectives included determining optimal time-to-surgery guidelines based on COVID-19 severity and discerning the influence of vaccination status on MACE risk.

Study design: National COVID Cohort Collaborative Data Enclave, a large multi-institutional dataset, was used to identify patients that underwent surgical cancer resection between January 2020 and February 2023. Multivariate regression analysis adjusting for demographics, comorbidities, and risk of surgery was performed to evaluate risk for 30-day postoperative MACE.

Results: Of 204,371 included patients, 21,313 (10.4%) patients had a history of preoperative COVID-19. History of COVID-19 was associated with an increased risk for postoperative composite MACE as well as 30-day mortality. Among patients with mild disease who did not require hospitalization, MACE risk was elevated for up to 4 weeks after infection. Postoperative MACE risk remained elevated more than 8 weeks after infection in those with moderate disease. Vaccination did not reduce risk for postoperative MACE.

Conclusions: Together, these data highlight that assessment of the severity of preoperative COVID-19 infection should be a routine component of both preoperative patient screening as well as surgical risk stratification. In addition, strategies beyond vaccination that increase patients' cardiovascular fitness and prevent COVID-19 infection are needed.

Figure 1.

History of preoperative COVID-19 and risk of compositive 30-day postoperative major adverse cardiac events in patients undergoing surgical cancer resection. Graphs show aOR with 95% confidence interval.

Figure 2.

History of preoperative COVID-19 and risk of specific 30-day postoperative cardiovascular and cerebrovascular outcomes in patients undergoing surgical cancer resection. Graphs show aOR (History of COVID-19, with no history of COVID-19 as reference) and 95% confidence interval. N (%) shows proportion of COVID-19 positive patients presenting with the specific outcome. All models were adjusted for sex, age, race/ethnicity, smoking status, comorbidity score, and relative risk of surgery.

Figure 3.

The association between 30-day postoperative MACE risk and (A) Timing between COVID-19 and surgery, (B) severity of COVID-19 and (C) interplay between disease severity and time to surgery among patients with preoperative COVID-19 undergoing surgical cancer resection. Graphs show aOR (reference: no history of COVID-19) with 95% confidence interval. N (%) shows proportion of COVID-19 positive patients within each severity or time-to- surgery category. All models were adjusted for sex, age, race/ethnicity, smoking status, comorbidity score, and relative risk of surgery.

Figure 4.

The association between 30-day postoperative MACE risk and full vaccination status prior to COVID-19/ surgery among patients (A) with and (B) without a history of preoperative COVID-19 undergoing surgical cancer resection. Graphs show aOR with 95% confidence interval.