COVID-19 and postoperative complications after plastic surgery procedures: More than just hypercoagulability

Abstract

BackgroundWhile plastic surgery procedures generally demonstrate a less than 2% incidence of VTE outcomes, the post-COVID era data remains elusive. This study sought to elucidate the relationship between COVID-19 infection and the risk of VTE outcomes across plastic surgery procedures. MethodsPlastic surgery procedures were identified in the 2012-2022 National Surgical Quality Improvement Program databases. The outcomes of interest were the postoperative occurrence of VTE, defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), and the occurrence of any postoperative complication. Propensity score matching was used to 1) compare overall rates of VTE between pre-pandemic era and pandemic era cohorts, and 2) compare rates of VTE and overall postoperative complications in cases with and without COVID-19 diagnosis in years 2021-2022 (p<0.05). Results269,006 plastic surgery cases were identified, comprising largely general breast (76%) and trunk (9.4%) procedures. Non-breast free tissue transfer cases were associated with the highest rates of DVT (1.3%) and trunk procedures with the highest rates of PE (0.7%). After propensity score matching, the overall rate of VTE after the onset of the COVID-19 pandemic was not significantly different from the pre-pandemic era (p=0.40). In a separately matched cohort, COVID-19 diagnosis did not significantly predict risk of VTE (p=0.48) but did significantly predict risk of overall postoperative complications (p<0.001). ConclusionsWhile COVID-19 diagnosis itself did not predict risk of VTE upon matched analysis, it significantly predicted overall postoperative complications. Future studies may further investigate effects of COVID-19 infection over longer periods of follow up.