The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis
Aims: This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Methods: Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2023-09-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.49.BJO-2023-0053 |
| _version_ | 1797672299755732992 |
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| author | Michael R. Mercier Robert Koucheki Johnathan R. Lex Amir Khoshbin Sam S. Park Timothy R. Daniels Mansur M. Halai |
| author_facet | Michael R. Mercier Robert Koucheki Johnathan R. Lex Amir Khoshbin Sam S. Park Timothy R. Daniels Mansur M. Halai |
| author_sort | Michael R. Mercier |
| collection | DOAJ |
| description | Aims: This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Methods: Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events. Results: Of 194,121 included patients, 740 (0.38%) were identified to be COVID-19-positive. Comparison of comorbidities demonstrated that COVID-19-positive patients had higher rates of diabetes, heart failure, and pulmonary disease. After propensity matching and controlling for all preoperative variables, multivariable analysis found that COVID-19-positive patients were at increased risk of several postoperative complications, including: any adverse event, major adverse event, minor adverse event, death, venous thromboembolism, and pneumonia. COVID-19-positive patients undergoing hip/knee arthroplasty and trauma surgery were at increased risk of 30-day adverse events. Conclusion: COVID-19-positive patients undergoing orthopaedic surgery had increased odds of many 30-day postoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-risk procedures. These data reinforce prior literature demonstrating increased risk of venous thromboembolic events in the acute postoperative period. Clinicians caring for patients undergoing orthopaedic procedures should be mindful of these increased risks, and attempt to improve patient care during the ongoing global pandemic. Cite this article: Bone Jt Open 2023;4(9):704–712. |
| first_indexed | 2024-03-11T21:27:56Z |
| format | Article |
| id | doaj.art-7b540e19806f4ed8b5afd1b345d47257 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-11T21:27:56Z |
| publishDate | 2023-09-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-7b540e19806f4ed8b5afd1b345d472572023-09-27T14:59:50ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622023-09-014970471210.1302/2633-1462.49.BJO-2023-0053The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysisMichael R. Mercier0Robert Koucheki1https://orcid.org/0000-0002-6156-6660Johnathan R. Lex2https://orcid.org/0000-0002-8171-5344Amir Khoshbin3https://orcid.org/0000-0002-0891-3424Sam S. Park4Timothy R. Daniels5Mansur M. Halai6University of Toronto Division of Orthopaedic Surgery, Toronto, CanadaUniversity of Toronto Faculty of Medicine, Toronto, CanadaUniversity of Toronto Division of Orthopaedic Surgery, Toronto, CanadaUniversity of Toronto Division of Orthopaedic Surgery, Toronto, CanadaUniversity of Toronto Division of Orthopaedic Surgery, Toronto, CanadaUniversity of Toronto Division of Orthopaedic Surgery, Toronto, CanadaUniversity of Toronto Division of Orthopaedic Surgery, Toronto, CanadaAims: This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Methods: Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events. Results: Of 194,121 included patients, 740 (0.38%) were identified to be COVID-19-positive. Comparison of comorbidities demonstrated that COVID-19-positive patients had higher rates of diabetes, heart failure, and pulmonary disease. After propensity matching and controlling for all preoperative variables, multivariable analysis found that COVID-19-positive patients were at increased risk of several postoperative complications, including: any adverse event, major adverse event, minor adverse event, death, venous thromboembolism, and pneumonia. COVID-19-positive patients undergoing hip/knee arthroplasty and trauma surgery were at increased risk of 30-day adverse events. Conclusion: COVID-19-positive patients undergoing orthopaedic surgery had increased odds of many 30-day postoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-risk procedures. These data reinforce prior literature demonstrating increased risk of venous thromboembolic events in the acute postoperative period. Clinicians caring for patients undergoing orthopaedic procedures should be mindful of these increased risks, and attempt to improve patient care during the ongoing global pandemic. Cite this article: Bone Jt Open 2023;4(9):704–712.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.49.BJO-2023-0053covidnsqipperioperative complicationstraumaarthroplastypostoperative complicationsorthopaedic procedurescovid-19 pandemiccomorbiditiestrauma surgeryhip and knee arthroplastyhip and knee arthroplastypropensity score matchingpneumoniavenous thromboembolism |
| spellingShingle | Michael R. Mercier Robert Koucheki Johnathan R. Lex Amir Khoshbin Sam S. Park Timothy R. Daniels Mansur M. Halai The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis Bone & Joint Open covid nsqip perioperative complications trauma arthroplasty postoperative complications orthopaedic procedures covid-19 pandemic comorbidities trauma surgery hip and knee arthroplasty hip and knee arthroplasty propensity score matching pneumonia venous thromboembolism |
| title | The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis |
| title_full | The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis |
| title_fullStr | The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis |
| title_full_unstemmed | The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis |
| title_short | The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis |
| title_sort | association between preoperative covid 19 positivity and acute postoperative complication risk among patients undergoing orthopedic surgery a matched cohort analysis |
| topic | covid nsqip perioperative complications trauma arthroplasty postoperative complications orthopaedic procedures covid-19 pandemic comorbidities trauma surgery hip and knee arthroplasty hip and knee arthroplasty propensity score matching pneumonia venous thromboembolism |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.49.BJO-2023-0053 |
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