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A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? – Lumbar Fusion

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This article discusses the impact of COVID-19 on perioperative complications after spine surgery and the optimal timing of surgery following a COVID-19 infection. The study used the NIH National COVID Cohort Collaborative (N3C) database to analyze the risk profile of patients undergoing lumbar spinal fusion surgery within different time windows after a COVID-19 infection. The results showed that patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events, sepsis, 30-day mortality, and 1-year mortality compared to COVID-negative patients during the same period. However, there was no significant difference in the rates of acute kidney injury or surgical site infection. Patients who underwent surgery between 2 and 6 weeks or between 6 and 12 weeks after the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. The study concludes that for non-urgent spine surgeries, it may be advisable to postpone the procedure for at least 2 weeks following a COVID-19 infection, or to consider a more aggressive blood clot prevention regimen for urgent surgery in COVID-19 patients

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

S: Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.

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N Am Spine Soc J. 2023 Aug 11;16:100262. doi: 10.1016/j.xnsj.2023.100262. eCollection 2023 Dec.ABSTRACTBACKGROUND CONTEXT: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C),

N Am Spine Soc J. 2023 Aug 11;16:100262. doi: 10.1016/j.xnsj.2023.100262. eCollection 2023 Dec.

ABSTRACT

BACKGROUND CONTEXT: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection.

METHODS: We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery.

RESULTS: A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58-3.32), sepsis (OR 1.56, 95% CI 1.03-2.36), 30-day mortality (OR 5.55, 95% CI 3.53-8.71), and 1-year mortality (OR 2.70, 95% CI 1.91-3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed.

S: Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.

PMID:37720242 | PMC:PMC10504527 | DOI:10.1016/j.xnsj.2023.100262

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A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed?

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N Am Spine Soc J. 2023 Aug 11;16:100262. doi: 10.1016/j.xnsj.2023.100262. eCollection 2023 Dec.ABSTRACTBACKGROUND CONTEXT: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C)

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