The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States

<jats:sec> <jats:title>Objective:</jats:title> <jats:p>To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications.</jats:p> </jats:sec> <jats:sec> <jats:title>Summary Background Data:</jats:title> <jats:p>It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>The risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 (“pre-Covid-19”), (2) 0 to 4 weeks after SARS-CoV-2 infection (“peri-Covid-19”), (3) 4 to 8 weeks after infection (“early post-Covid-19”), and (4) ≥8 weeks after infection (“late post-Covid-19”).</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06–10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22–5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35–5.53), and sepsis (aOR, 3.67; 95% CI: 2.18–6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20–4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.</jats:p> </jats:sec>