The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: A MATCHED COHORT ANALYSIS

Abstract

Aims This study aimed to investigate the risk of postoperative complications in COVID-19-positivepatients undergoing common orthopaedic procedures.Methods Using the National Surgical Quality Improvement Programme (NSQIP) database, patientswho underwent common orthopaedic surgery procedures from 1 January to 31 December2021 were extracted. Patient preoperative COVID-19status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positiveand -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-daypostoperative adverse events. Results Of 194,121 included patients, 740 (0.38%) were identified to be COVID-19-positive.Comparisonof comorbidities demonstrated that COVID-19-positivepatients 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-positivepatientswere at increased risk of several postoperative complications, including: any adverse event, major adverse event, minor adverse event, death, venous thromboembolism, and pneumonia.COVID-19-positivepatients undergoing hip/knee arthroplasty and trauma surgery wereat increased risk of 30-dayadverse events.Conclusion COVID-19-positivepatients undergoing orthopaedic surgery had increased odds of many30-daypostoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-riskprocedures. These data reinforce prior literature demonstrating increasedrisk 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.