Naslov
Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

Autori
COVIDSurg Collaborative ; GlobalSurg Collaborative

Kolaboracija
COVIDSurg Collaborative ; GlobalSurg Collaborative

Izvornik
Anaesthesia (0003-2409) 76 (2021), 11; 1454-1464

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
SARS-Cov-2 ; COVID-19 ; surgery ; pathways ; pre-operative isolation

Sažetak
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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Javno zdravstvo i zdravstvena zaštita

Napomena
Autori na kolaboraciji navedeni na kraju rada (Appendix S1 COVIDSurg Collaborative and GlobalSurg Collaborative authors.)
Writing group:
Joana FF Simoes* (Portugal), Dmitri Nepogodiev* (UK), Adesoji Ademuyiwa (Nigeria), Igor Buarque (Brazil), Kariem El-Boghdadly (UK), Mengistu Gebreyohanes (Ethiopia), James C Glasbey (UK), Irmgard E. Kronberger (Austria), Schelto Kruijff (Netherlands), Elizabeth Li (UK), Markus Löffler (Germany), Hassan Mashbari (USA), Francesco Pata (Italy), Neil Smart (UK), Raza Sayyed (Pakistan), Sebastian Shu (Peru), Malin Sund (Sweden), Aneel Bhangu (UK).
Croatia: Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic
Hospital Leads:Croatia: Jakov Mihanovic (Zadar General Hospital, Zadar).
Local Collaborators:
Croatia: Kristina Bitunjac, Karlo Grulović, Marijana Vučković (General and Veterans Hospital ‘Hrvatski Ponos’ Knin, Knin); Goran Šantak (County General Hospital Pozega, Pozega); Emanuel Borovic, Ana Bosak Versic, Damir Hasandić, Natasa Poldan Grabar, Suzana Srsen Medancic (University Hospital Center Rijeka, Rijeka); Lucija Brkic, Sara Cokarić, Petra Pavic Palac, Zeljka Samac, Josipa Tomić, Marija Vrdoljak (General Hospital Sibenik, Sibenik); Ivan Bacic, Bernarda Bakmaz, Nikolina Bratošević Vučičić, Domagoj Brzic, Samir Canovic, Emilio Dijan, Maja Grgec Dragicevic, Robert Karlo, Suzana Konjevoda, Petra Kovačević, Ivan Kovačić, Frane Markulić, Luka Matak, Jakov Mihanovic, Domagoj Morović, Gordan Perišić, Andrea Simic, Neven Skitarelić, Matea Veršić, Vanja Žufić, Matea Zuzul (Zadar General Hospital, Zadar); Srdan Ante Anzic, Iva Carevic, Dubravka Heli Litvic, Duska Markov-Glavas, Tatjana Savic Jovanovic (Children’s Hospital Srebrnjak, Zagreb); Goran Augustin, Jerko Biloš, Bojan Biočina, Vedrana Biosic, Dino Bobovec, Iva Botica, Boris Bumber, Petra Čerina, Ana Danic Hadzibegovic, Katarina Duric Vukovic, Hrvoje Gasparovic, Lucija Gatin, Kresimir Grsic, Ika Gugić Radojković, Ivan Jelčić, Zeljko Kastelan, Juraj Kolak, Tomislav Kopjar, Tomislav Kulis, Kristian Kunjko, Marjan Maric, Marcel Marjanović Kavanagh, Borna Milicic, Trpimir Morić, Miram Pasini, Luka Penezić, Drago Prgomet, Ratko Prstacic, Andreja Prtorić, Rudolf Radojković, Ivan Romić, Tomislav Sečan, Dora Škrljak Šoša, Juraj Slipac, Mislav Tomic, Jurica Zedelj, Toni Zekulić, Zoran Zimak (University Hospital Centre Zagreb, Zagreb); Mia Lorencin, Ivica Luksic, Matija Mamic (University Hospital Dubrava, Zagreb

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