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

• DOI: 10.1016/j.eclinm.2023.101881
• Publication Date: 2023-03-01T11:06:34Z
• Authors: Marc Garnier; Jean-Michel Const...; 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 Const...; Raphaël Cinotti; Chafia Daoui; Marc Leone; Nathanaël Lapidus; El Mahdi Hafiani; Christophe Quesnel; Olivier Imauven; Sigismond Lasocki; Emmanuel Rineau; Maxime Léger; Marc Danguy des D...; 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 R...; Céline Delerue; Virginie Trehel-T...; 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-L...; Samy Figueiredo; Antonia Blanié; Olivier Joannes-B...; 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
• Keywords: Medicine (General); [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology; Respiratory complications; Postoperative pneumonia; 610; COVID-19; Articles; Acute respiratory failure; Prognosis; 3. Good health; Anaesthesia; R5-920; 616; Surgery; Perioperative risk; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

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.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.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).In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity.The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).