THE ASSOCIATION BETWEEN PREOPERATIVE COVID-POSITIVITY AND ACUTE POSTOPERATIVE COMPLICATION RISK AMONG PATIENTS UNDERGOING ORTHOPAEDIC SURGERY: A MATCHED COHORT ANALYSIS

There is evidence demonstrating an association between pre-operative Coronavirus-Disease-2019 (COVID-19) positivity and peri-operative complications. The relationship between COVID-19 positivity and population demographics, patient comorbidities, and types of surgical intervention allows for enhanced healthcare optimization, resource allocation, patient counseling, and care planning. This study aimed to understand the relationship between COVID-19 positivity in patients undergoing common orthopaedic surgery and the risk of adverse post-operative complications. Using the National Surgical Quality Improvement Program (NSQIP) database, data on patients who underwent the most common orthopaedic surgery from January 1st – December 31st 2021were extracted. Data on patient pre-operative COVID-status, demographics, comorbidities, type of surgery, and post-operative complications were analyzed. COVID-positive versus negative patients were compared and propensity-score matching was conducted. Multivariate regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events. Of 194,121 patients who underwent orthopaedic surgery in 2021, 740 (0.38%) were identified to be COVID-positive. Among the included patients, 108,902 (56.1%) underwent hip/knee arthroplasty surgery, 27,089 (14.0%) trauma surgery, 25,762 (13.3%) spine surgery, 15,777 (8.1%) sports surgery, and 16,591 (8.6%) shoulder surgery. When comparing baseline population demographics, COVID-positive patients had a significantly higher age (71.1 ± 16.5 vs. 64.7 ± 14.8, p<0.001), lower body mass index (BMI) (26.5± 9.0 vs. 29.9 ± 8.6 units kg/m2, p<0.001), and higher American Society of Anesthesiologists (ASA) classification scores (p<0.001). Among COVID-positive cases, a higher proportion were deemed urgent or emergent (42.3% vs. 11.6%, p<0.001). Comparison of comorbidities demonstrated that COVID-positive patients had higher rates of diabetes mellitus (9.2% vs. 4.4%, p<0.001), congestive heart failure (10.0% vs. 3.0%, p<0.001), had a history of severe chronic obstructive pulmonary disease (COPD) (10.27% vs. 4.20%, p<0.001), were ventilator dependent (0.3% vs. 0.0%, p<0.001), and had higher rates of chronic steroid use (6.5% vs. 4.2%, p=0.002). After propensity matching and controlling for all preoperative variables, multivariate analysis found that COVID-positive patients were at increased risk of several postoperative complications, including: any adverse event [odds ratio (OR) = 2.29, p<0.001], major adverse event (OR = 2.27, p<0.001), minor adverse event (OR = 2.57, p<0.001), death (OR = 2.63, p<0.001), venous thromboembolism (OR = 1.81, p<0.001), and pneumonia (OR = 4.91, p<0.001). COVID-positive patients undergoing hip/knee arthroplasty (OR = 2.59, p<0.001) and trauma surgery (OR = 1.79, p<0.001) were at increased risk of 30-day adverse events. With regards to other postoperative outcomes, COVID-positive patients were at increased risk for: longer lengths of stay (OR = 5.2, p<0.001), discharge to non-home facilities (OR = 2.48, p<0.001), and readmission (OR = 1.52, p=0.004). COVID-positive patients undergoing orthopaedic surgery had increased odds of many 30-day postoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-risk procedures. Furthermore, this data reinforces prior literature demonstrating increased risk of venous thromboembolic events in the acute postoperative period. Clinicians caring for patients undergoing orthopaedic should be mindful of these increased risks and attempt to improve patient care during the ongoing global pandemic.