Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study. (April 2023)

• Record Type: Journal Article
• Authors: Garnier, Marc; Constantin, Jean-Michel; Cinotti, Raphaël; Daoui, Chafia; Margetis, Dimitri; Destruhaut, Grégory; Cirenei, Cédric; Noll, Eric; Quesnel, Christophe; Lecinq, Agnes; Lasocki, Sigismond; Charbonneau, Hélène; Abrard, Stanislas; Quemeneur, Cyril; Pastene, Bruno; Lapidus, Nathanaël; Leone, Marc; Garnier, Marc; Constantin, Jean-Michel; Cinotti, Raphaël; Daoui, Chafia; Leone, Marc; Lapidus, Nathanaël; Hafiani, El Mahdi; Quesnel, Christophe; Imauven, Olivier; Lasocki, Sigismond; Rineau, Emmanuel; Léger, Maxime; Danguy des Deserts, Marc; Schmitt, Johan; Aries, Philippe; Gouel, Aurélie; Voulgaropoulos, Julia; Soldan, Laura; Deransy, Romain; Laurent, Quentin; Gayat, Etienne; Verdonk, Franck; Chaouche, Sabrina; Cambriel, Amélie; Degos, Vincent; Dupont, Julie; Daoud, Laura; Margetis, Dimitri; Salettes, Romain; Favreau, Malory; Noll, Eric; Pottecher, Julien; Diemunsch, Sophie; Abrard, Stanislas; Bidon, Cyril; Roy, Clémence; Destruhaut, Grégory; Ottolenghi, Laëtitia; Edouard, Damien; Lecinq, Agnès; Mercier, Frédéric; Cirenei, Cédric; Garrigue, Delphine; Jozefowicz, Elsa; Pariès, Marie; Espitalier, Fabien; Piat, Charlène; Descamps, Richard; Duchesne, Maëlle; Sigaut, Stéphanie; Thion, Laurie-Anne; Renard, Julie; Brocas, Elsa; Zbidi, Besma; Fki, Mohamed; Quemeneur, Cyril; Dufour, Guillaume; Bucciero, Mario; Rochon, Charles-Edouard; Delerue, Céline; Trehel-Tursis, Virginie; Raft, Julien; Rangeard, Olivier; Thiriet, Claire; Lagarde, Kevin; Pollet, Angélina; Pelen, Félix; Caillard, Anaïs; Penven, Philippe; Huet, Olivier; Puel, Floriane; Pichon, Xavier; Ligneres, Laetitia; Bleuze, Pauline; Deryckere, Stéphanie; Velly, Lionel; Simeone, Pierre; Andrianjatovo, Hery; Chipouline, Youri; Boolad, Mouna; Frasca, Denis; Plouviez, Quentin; Plaud, Benoit; Roland, Eric; Cheron-Leroy, Delphine; Figueiredo, Samy; Blanié, Antonia; Joannes-Boyau, Olivier; Monziols, Simon; Robin, Jean-Jacques; Biais, Matthieu; De Courson, Hugues; Degryse, Cécile; Do-Khac, Marie; Bonnet, Marie-Pierre; Mazeraud, Aurélien; Bardon, Jean; Bouchereau, Eléonore; Pastene, Bruno; Bezulier, Karine; Charbonneau, Hélène; Mrozek, Ségolène; Mayeur, Nicolas; Lopez, Sandrine;
• Is Part Of: EClinicalMedicine. Volume 58(2023)
• Publication Date: 2023-04
• Subjects: COVID-19 -- Anaesthesia -- Surgery -- Perioperative risk -- Respiratory complications -- Postoperative pneumonia -- Acute respiratory failure -- Prognosis; Medicine -- Research -- Periodicals; Medical policy -- Periodicals; Clinical Medicine; Health Policy; Public Health; Medical policy; Medicine -- Research; Periodical; Electronic journals; Periodicals; 613
• DOI: 10.1016/j.eclinm.2023.101881
• Languages: English
• ISSNs: 2589-5370

Abstract

Summary: Background: Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. Methods: We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. Findings: Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48–2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02–15.8]; p = 0.04). Interpretation: In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. Funding: The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).