目的:评估术前感染现代严重急性呼吸道冠状病毒2(SARS-CoV-2)对术后死亡率的影响,呼吸系统发病率和肺外并发症选修后,非心脏手术.
方法:一项双向观察性队列研究。
方法:上海某三级教学医院,中国。
方法:所有接受择期手术的成年患者(≥18岁),从1月至2023年3月在复旦大学附属华山医院进行的全身麻醉非心脏手术筛选资格.共纳入2907例患者。
方法:术前冠状病毒病2019(COVID-19)阳性。
方法:主要结局是术后30天死亡率。次要结果包括术后肺部并发症(PPCs),非心脏手术(MINS)后的心肌损伤,急性肾损伤(AKI),术后谵妄(POD)与术后睡眠质量的关系。多变量logistic回归用于评估术前COVID-19引起的术后死亡率和发病率的风险。
结果:术后30天死亡的风险与术前COVID-19[校正比值比(aOR),95%置信区间(CI):0.40,0.13-1.28,P=0.123]或相对于诊断的手术时机。术前COVID-19没有增加PPC的风险(aOR,95%CI:0.99,0.71-1.38,P=0.944),MINS(AOR,95%CI:0.54,0.22-1.30;P=0.168),或AKI(AOR,95%CI:0.34,0.10-1.09;P=0.070)或影响术后睡眠质量。在COVID-19后7周内接受手术的患者发生谵妄的几率增加(aOR,95%CI:2.26,1.05-4.86,P=0.036)。
结论:术前COVID-19或相对于诊断的手术时机没有增加术后30天死亡的风险,PPCs,MINS或AKI。然而,最近COVID-19增加了POD的风险。在对COVID-19幸存者进行术前风险评估时,应考虑围手术期脑健康。
To assess the impact of preoperative infection with the contemporary strain of severe acute respiratory coronavirus 2 (SARS-CoV-2) on postoperative mortality, respiratory morbidity and extrapulmonary complications after elective, noncardiac surgery.
An ambidirectional observational cohort study.
A tertiary and teaching hospital in Shanghai, China.
All adult patients (≥ 18 years of age) who underwent elective, noncardiac surgery under general anesthesia at Huashan Hospital of Fudan University from January until March 2023 were screened for eligibility. A total of 2907 patients were included.
Preoperative coronavirus disease 2019 (COVID-19) positivity.
The primary outcome was 30-day postoperative mortality. The secondary outcomes included postoperative pulmonary complications (PPCs), myocardial injury after noncardiac surgery (MINS), acute kidney injury (AKI), postoperative delirium (POD) and postoperative sleep quality. Multivariable logistic regression was used to assess the risk of postoperative mortality and morbidity imposed by preoperative COVID-19.
The risk of 30-day postoperative mortality was not associated with preoperative COVID-19 [adjusted odds ratio (aOR), 95% confidence interval (CI): 0.40, 0.13-1.28, P = 0.123] or operation timing relative to diagnosis. Preoperative COVID-19 did not increase the risk of PPCs (aOR, 95% CI: 0.99, 0.71-1.38, P = 0.944), MINS (aOR, 95% CI: 0.54, 0.22-1.30; P = 0.168), or AKI (aOR, 95% CI: 0.34, 0.10-1.09; P = 0.070) or affect postoperative sleep quality. Patients who underwent surgery within 7 weeks after COVID-19 had increased odds of developing delirium (aOR, 95% CI: 2.26, 1.05-4.86, P = 0.036).
Preoperative COVID-19 or timing of surgery relative to diagnosis did not confer any added risk of 30-day postoperative mortality, PPCs, MINS or AKI. However, recent COVID-19 increased the risk of POD. Perioperative brain health should be considered during preoperative risk assessment for COVID-19 survivors.