Abstract
Background:It is unknownwhetherrecovery fromcoronavirus disease 2019 (COVID-19)infectionleads to an increasedneed forcommonsurgical procedures.Our objective was to conduct an exploratory analysis of surgical procedures performed after a documentedCOVID-19 infection. Methods:We conducted a retrospective cohort study using routinely collected data from the province of Ontario, Canada. We identifiedindividuals with apositiveCOVID-19 testbetween February 1 2020 and May 31 2020, and matched them 1:2 with individuals who had a negativeCOVID-19 testduring the same period. We used physician billing codes to identify the ten most frequent surgical procedures intheCOVID-19 cohort.Anat-riskperiod 30 days after the first positiveCOVID-19 swab (or matched index date in the control group) until November 30 2020 wasused.Cox proportional hazard models (adjusted for important baseline differences)are reported withhazard ratios (HR)and 95% confidence intervals. Results:After exclusions and matching, wehad19,143people in theCOVID-19 cohort, and 38,286 people in the control cohort.The top ten surgical procedures were hand/wrist fracture fixation,cesarean-section, ureteral stent placement, cholecystectomy, treatment of an upper tract urinary stone, hysterectomy, femur fracture repair, hip replacement, transurethral prostatectomy, and appendectomy.There was a significantly reduced hazard of requiring upper tract renal stone surgery(adjusted hazard ratio [aHR]0.50, 95%confidence interval [CI]0.29-0.87)or ureteral stent placement(aHR0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy(aHR0.43, 95%CI 0.26-0.71)amongthose withapriorpositiveCOVID-19 test. Conclusions:After aCOVID-19 infection there is not an increased riskof needingseveralcommon surgical procedures. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy, however understanding the reasons for this will requirefurtherstudy.
Highlights
The coronavirus disease 2019 (COVID-19) global pandemic has led to fundamental shifts in everyday life around the world
As a previously unknown disease, an important part of this research process is exploratory analyses to determine which health conditions may be more prominent after a COVID-19 infection; this led to important studies which have identified the risk of long-term sequela such as neurologic, metabolic, cardiovascular and gastrointestinal disorders that are recognized as being part of long-COVID-19.2,3
Most of the early study of COVID-19 centered around how surgical practices changed in response to the pandemic,[4] safe operating room practices,[5] or the abnormally high surgical mortality rate associated with operating on a COVID-19 patient.[6]
Summary
The coronavirus disease 2019 (COVID-19) global pandemic has led to fundamental shifts in everyday life around the world. Given the wide-ranging impact of COVID-19 across several different organs, and the fact there is still much to be understood about long COVID-19, it is possible that patients with a previous COVID-19 infection are at an elevated risk of diseases that are managed operatively. Knowledge of this would be important for patients, physicians treating COVID-19 patients, and the surgical community. There was a significantly reduced hazard of requiring upper tract renal stone surgery (adjusted hazard ratio [aHR] 0.50, 95% confidence interval [CI] 0.29-0.87) or ureteral stent placement (aHR 0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy (aHR 0.43, 95%CI 0.260.71) among those with a prior positive COVID-19 test. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy,
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