TY - JOUR
T1 - SARS-CoV-2 infection and venous thromboembolism after surgery
T2 - an international prospective cohort study
AU - G4 Alliance
AU - GlobalPaedSurg
AU - Global Initiative for Children's Surgery (GICS)
AU - ItSURG
AU - Irish Surgical Research Collaborative (ISRC)
AU - Italian Society of Colorectal Surgery (SICCR)
AU - PTSurg
AU - S-ECCO
AU - South African Society of Anaesthesiologists
AU - SpainSurg
AU - COVIDSurg Collaborative
AU - GlobalSurg Collaborative
AU - Association of Surgeons in Training (ASiT)
AU - European Society of Coloproctology (ESCP)
AU - EuroSurg
AU - Agastra, Ervis
AU - Thereska, Dariel
AU - Dajti, Irida
AU - Lucchini, Sergio Martin
AU - Laudani, Veronica
AU - Boccalatte, Luis
AU - Chwat, Carina
AU - Pedraza Salazar, Ivana Ines
AU - Pantoja Pachajoa, Diana Alejandra
AU - Duro, Agustin
AU - Calderón Arancibia, José Alfredo
AU - Cox, Daniel
AU - D’aulerio, Giuliana
AU - Dudi-Venkata, Nagendra
AU - Egoroff, Natasha
AU - Farik, Shebani
AU - Lott, Natalie
AU - Moss, Jana Lee
AU - Pockney, Peter
AU - Rennie, Sarah
AU - Tan, Lorwai
AU - Varghese, Christopher
AU - Vo, Uyen Giao
AU - Watson, David
AU - Watters, David
AU - Wright, Deborah
AU - Bright, Tim
AU - Hollington, Paul
AU - Zhou, Xuanyu
AU - Kroon, Hidde M.
AU - Farfus, Anthony
AU - Barker, John
AU - Watson, Eleanor
AU - Stevens, Sean
AU - Latif, Haider
AU - Dawson, Amanda Caroline
AU - Chuan, Alwin
AU - Muralidharan, Vijayaragavan
AU - Wong, Enoch
AU - Ackermann, Travis
AU - Pacilli, Maurizio
AU - Hodgson, Russell
AU - Heriot, Alexander
AU - De la Peña, Jairo
AU - Isaza-Restrepo, Andres
AU - Abaunza, Katherine Parra
AU - Rey Chaves, Carlos Eduardo
AU - Rubiano, Wilson
AU - Sabogal Olarte, Juan Carlos
AU - Salgado Tovar, Javier Mauricio
N1 - © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.
PY - 2022/1
Y1 - 2022/1
N2 - SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
AB - SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
KW - Adolescent
KW - Adult
KW - Age Distribution
KW - Aged
KW - COVID-19/complications
KW - Cohort Studies
KW - Female
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Postoperative Complications/etiology
KW - Prospective Studies
KW - SARS-CoV-2
KW - Sex Distribution
KW - Venous Thromboembolism/etiology
KW - Young Adult
UR - https://www.scopus.com/pages/publications/85122545923
U2 - 10.1111/anae.15563
DO - 10.1111/anae.15563
M3 - Artículo
C2 - 34428858
AN - SCOPUS:85122545923
SN - 0003-2409
VL - 77
SP - 28
EP - 39
JO - Anaesthesia
JF - Anaesthesia
IS - 1
ER -