A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed?
Background Context: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to c...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548423000641 |
| _version_ | 1797390369344716800 |
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| author | Justin P. Chan, MD Henry Hoang, BS Sohaib Z. Hashmi, MD Yu-Po Lee, MD Nitin N. Bhatia, MD |
| author_facet | Justin P. Chan, MD Henry Hoang, BS Sohaib Z. Hashmi, MD Yu-Po Lee, MD Nitin N. Bhatia, MD |
| author_sort | Justin P. Chan, MD |
| collection | DOAJ |
| description | Background Context: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection. Methods: We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery. Results: A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58–3.32), sepsis (OR 1.56, 95% CI 1.03–2.36), 30-day mortality (OR 5.55, 95% CI 3.53–8.71), and 1-year mortality (OR 2.70, 95% CI 1.91–3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. Conclusions: Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients. |
| first_indexed | 2024-03-08T23:10:43Z |
| format | Article |
| id | doaj.art-b708ccbd073641a193170d4f758e9adb |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-03-08T23:10:43Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-b708ccbd073641a193170d4f758e9adb2023-12-15T07:26:26ZengElsevierNorth American Spine Society Journal2666-54842023-12-0116100262A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed?Justin P. Chan, MD0Henry Hoang, BS1Sohaib Z. Hashmi, MD2Yu-Po Lee, MD3Nitin N. Bhatia, MD4Corresponding author. Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States. Tel.: 714-456-7012.; Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United StatesDepartment of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United StatesDepartment of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United StatesDepartment of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United StatesDepartment of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United StatesBackground Context: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection. Methods: We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery. Results: A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58–3.32), sepsis (OR 1.56, 95% CI 1.03–2.36), 30-day mortality (OR 5.55, 95% CI 3.53–8.71), and 1-year mortality (OR 2.70, 95% CI 1.91–3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. Conclusions: Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.http://www.sciencedirect.com/science/article/pii/S2666548423000641COVID-19CoronavirusSARS-CoV2Lumbar fusion |
| spellingShingle | Justin P. Chan, MD Henry Hoang, BS Sohaib Z. Hashmi, MD Yu-Po Lee, MD Nitin N. Bhatia, MD A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? North American Spine Society Journal COVID-19 Coronavirus SARS-CoV2 Lumbar fusion |
| title | A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? |
| title_full | A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? |
| title_fullStr | A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? |
| title_full_unstemmed | A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? |
| title_short | A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? |
| title_sort | temporal analysis of perioperative complications following covid 19 infection in patients undergoing lumbar spinal fusion when is it safe to proceed |
| topic | COVID-19 Coronavirus SARS-CoV2 Lumbar fusion |
| url | http://www.sciencedirect.com/science/article/pii/S2666548423000641 |
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