Perioperative Cardiovascular Considerations Prior to Elective Noncardiac Surgery in Patients With a History of COVID-19

Abstract

Surgery in Patients With a History of COVID-19Patients with cardiovascular risk factors (eg, age, hypertension, diabetes, obesity) and established cardiovascular disease (CVD) have excess morbidity and mortality with COVID-19. 1 Acute cardiovascular complications of COVID-19 can include myocardial injury, acute coronary syndrome, heart failure, arrhythmias, dysautonomia, and thromboembolism. 1 It remains unknown whether these cardiovascular complications of COVID-19 persist beyond the acute phase of illness.Prior studies indicate that hospitalization with non-COVID-19 pneumonia may be associated with an increased risk of CVD up to 10 years after the initial infection. 2any COVID-19 survivors are resuming routine clinical care and being referred for elective surgery.It is unclear if a history of recent COVID-19 warrants additional preoperative cardiac assessment.We outline key considerations for cardiac risk assessment in patients with recent COVID-19 undergoing evaluation for elective noncardiac surgery.In a large international prospective observational study from the GlobalSurg-COVIDSurg collaborative of 140 231 patients undergoing noncardiac surgery, 2.2% had a preoperative COVID-19 diagnosis. 3A majority of the patients with a preoperative COVID-19 diagnosis were younger than 70 years, were American Society of Anesthesiologists physical status class of 1 or 2, had revised cardiac risk index of 0 or 1, and reported either asymptomatic COVID-19 or experienced symptom resolution prior to the surgery.Among surgeries performed within 2 weeks of a COVID-19 diagnosis, 70.3% were emergent.The 30-day adjusted postoperative mortality was 3.6% to 4.1% in patients undergoing surgery within 7 weeks of a COVID-19 diagnosis, but only 1.5% in patients undergoing surgery 7 weeks or more after a COVID-19 diagnosis, similar to patients without a COVID-19 diagnosis.This association between postoperative mortality and the timing of COVID-19 diagnosis was observed irrespective of age, American Society of Anesthesiologists physical status class, major or minor surgery, emergent or elective surgery, or COVID-19 symptom status (asymptomatic, ongoing, or resolved respiratory or nonrespiratory symptoms).Among patients undergoing surgery 7 weeks or more after a COVID-19 diagnosis, those with ongoing COVID-19 symptoms had substantially higher 30-day postoperative mortality (6.0%) when compared with asymptomatic patients (1.3%) or those with symptom resolution (2.4%).Unfortunately, perioperative cardiovascular complications and causes of death were not reported in these analyses.However, the postoperative incidence of pulmonary complications was also greater in

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