Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery
Objective: To elucidate the effects of COVID-19 positivity within 12 weeks preceding metastasis-related surgical procedures on postoperative complications. Methods: We retrospectively analyzed 20,104,963 patients, of which 109,127 underwent surgery for metastatic processes. Patients were categorized...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-04-01
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| Series: | Journal of Orthopaedic Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X25000037 |
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| Summary: | Objective: To elucidate the effects of COVID-19 positivity within 12 weeks preceding metastasis-related surgical procedures on postoperative complications. Methods: We retrospectively analyzed 20,104,963 patients, of which 109,127 underwent surgery for metastatic processes. Patients were categorized based on COVID-19 status within 12 weeks of surgery: positive (1.49 %) and negative (98.51 %). Variables assessed included demographic data, body mass index (BMI), Charlson Comorbidity Index (CCI) scores, and various postoperative complications, such as venous thromboembolism (VTE), 30-day and 365-day all-cause mortality. Results: The COVID-19 positive cohort exhibited a significantly higher BMI (32.41 ± 8.14 vs. 33.43 ± 7.56, p < 0.001) and CCI score (2.94 ± 3.06 vs. 2.67 ± 2.89, p < 0.001). Additionally, they demonstrated elevated rates of VTE (2.64 % vs. 1.36 %), 30-day mortality (1.65 % vs. 0.39 %), and 365-day mortality (5.71 % vs. 2.02 %). Adjusted multivariate logistic regression highlighted COVID-19 positivity within 0–2 weeks of surgery and CCI >3 as significant predictors of VTE, 30-day, and 365-day mortality. Adjusted odds ratios associated with recent COVID-19 positivity for VTE, sepsis, surgical site infection, 30-day mortality, and 365-day mortality were 2.69, 1.74, 0.98, 5.49, and 4.27, respectively. For CCI>3, the respective odds ratios were 2.10, 5.03, 1.89, 6.33, and 9.04. Owing to limited events, odds ratios for bleeding and AKI were not established. Conclusions: Patients positive for COVID-19 within 12 weeks of metastasis-related surgery face heightened postoperative complications, particularly when positivity is within 0–2 weeks of surgery. Additionally, a CCI score >3 further augments this risk, emphasizing the need for meticulous perioperative management and strategic patient selection in the era of COVID-19. |
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| ISSN: | 2773-157X |