EClinicalMedicine (Apr 2023)

Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort studyResearch in context

  • Marc Garnier,
  • Jean-Michel Constantin,
  • Raphaël Cinotti,
  • Chafia Daoui,
  • Dimitri Margetis,
  • Grégory Destruhaut,
  • Cédric Cirenei,
  • Eric Noll,
  • Christophe Quesnel,
  • Agnes Lecinq,
  • Sigismond Lasocki,
  • Hélène Charbonneau,
  • Stanislas Abrard,
  • Cyril Quemeneur,
  • Bruno Pastene,
  • Nathanaël Lapidus,
  • Marc Leone,
  • Marc Garnier,
  • Jean-Michel Constantin,
  • Raphaël Cinotti,
  • Chafia Daoui,
  • Marc Leone,
  • Nathanaël Lapidus,
  • El Mahdi Hafiani,
  • Christophe Quesnel,
  • Olivier Imauven,
  • Sigismond Lasocki,
  • Emmanuel Rineau,
  • Maxime Léger,
  • Marc Danguy des Deserts,
  • Johan Schmitt,
  • Philippe Aries,
  • Aurélie Gouel,
  • Julia Voulgaropoulos,
  • Laura Soldan,
  • Romain Deransy,
  • Quentin Laurent,
  • Etienne Gayat,
  • Franck Verdonk,
  • Sabrina Chaouche,
  • Amélie Cambriel,
  • Vincent Degos,
  • Julie Dupont,
  • Laura Daoud,
  • Dimitri Margetis,
  • Romain Salettes,
  • Malory Favreau,
  • Eric Noll,
  • Julien Pottecher,
  • Sophie Diemunsch,
  • Stanislas Abrard,
  • Cyril Bidon,
  • Clémence Roy,
  • Grégory Destruhaut,
  • Laëtitia Ottolenghi,
  • Damien Edouard,
  • Agnès Lecinq,
  • Frédéric Mercier,
  • Cédric Cirenei,
  • Delphine Garrigue,
  • Elsa Jozefowicz,
  • Marie Pariès,
  • Fabien Espitalier,
  • Charlène Piat,
  • Richard Descamps,
  • Maëlle Duchesne,
  • Stéphanie Sigaut,
  • Laurie-Anne Thion,
  • Julie Renard,
  • Elsa Brocas,
  • Besma Zbidi,
  • Mohamed Fki,
  • Cyril Quemeneur,
  • Guillaume Dufour,
  • Mario Bucciero,
  • Charles-Edouard Rochon,
  • Céline Delerue,
  • Virginie Trehel-Tursis,
  • Julien Raft,
  • Olivier Rangeard,
  • Claire Thiriet,
  • Kevin Lagarde,
  • Angélina Pollet,
  • Félix Pelen,
  • Anaïs Caillard,
  • Philippe Penven,
  • Olivier Huet,
  • Floriane Puel,
  • Xavier Pichon,
  • Laetitia Ligneres,
  • Pauline Bleuze,
  • Stéphanie Deryckere,
  • Lionel Velly,
  • Pierre Simeone,
  • Hery Andrianjatovo,
  • Youri Chipouline,
  • Mouna Boolad,
  • Denis Frasca,
  • Quentin Plouviez,
  • Benoit Plaud,
  • Eric Roland,
  • Delphine Cheron-Leroy,
  • Samy Figueiredo,
  • Antonia Blanié,
  • Olivier Joannes-Boyau,
  • Simon Monziols,
  • Jean-Jacques Robin,
  • Matthieu Biais,
  • Hugues De Courson,
  • Cécile Degryse,
  • Marie Do-Khac,
  • Marie-Pierre Bonnet,
  • Aurélien Mazeraud,
  • Jean Bardon,
  • Eléonore Bouchereau,
  • Bruno Pastene,
  • Karine Bezulier,
  • Hélène Charbonneau,
  • Ségolène Mrozek,
  • Nicolas Mayeur,
  • Sandrine Lopez

Journal volume & issue
Vol. 58
p. 101881

Abstract

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Summary: Background: Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. Methods: We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. Findings: Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48–2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02–15.8]; p = 0.04). Interpretation: In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. Funding: The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).

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