Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery
Objective: To elucidate the effects of COVID-19 positivity within 12 weeks preceding metastasis-related surgical procedures on postoperative complications. Methods: We retrospectively analyzed 20,104,963 patients, of which 109,127 underwent surgery for metastatic processes. Patients were categorized...
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Elsevier
2025-04-01
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| Series: | Journal of Orthopaedic Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X25000037 |
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| author | Beshoy Gabriel Henry Hoang En Chang Justin P. Chan |
| author_facet | Beshoy Gabriel Henry Hoang En Chang Justin P. Chan |
| author_sort | Beshoy Gabriel |
| collection | DOAJ |
| description | Objective: To elucidate the effects of COVID-19 positivity within 12 weeks preceding metastasis-related surgical procedures on postoperative complications. Methods: We retrospectively analyzed 20,104,963 patients, of which 109,127 underwent surgery for metastatic processes. Patients were categorized based on COVID-19 status within 12 weeks of surgery: positive (1.49 %) and negative (98.51 %). Variables assessed included demographic data, body mass index (BMI), Charlson Comorbidity Index (CCI) scores, and various postoperative complications, such as venous thromboembolism (VTE), 30-day and 365-day all-cause mortality. Results: The COVID-19 positive cohort exhibited a significantly higher BMI (32.41 ± 8.14 vs. 33.43 ± 7.56, p < 0.001) and CCI score (2.94 ± 3.06 vs. 2.67 ± 2.89, p < 0.001). Additionally, they demonstrated elevated rates of VTE (2.64 % vs. 1.36 %), 30-day mortality (1.65 % vs. 0.39 %), and 365-day mortality (5.71 % vs. 2.02 %). Adjusted multivariate logistic regression highlighted COVID-19 positivity within 0–2 weeks of surgery and CCI >3 as significant predictors of VTE, 30-day, and 365-day mortality. Adjusted odds ratios associated with recent COVID-19 positivity for VTE, sepsis, surgical site infection, 30-day mortality, and 365-day mortality were 2.69, 1.74, 0.98, 5.49, and 4.27, respectively. For CCI>3, the respective odds ratios were 2.10, 5.03, 1.89, 6.33, and 9.04. Owing to limited events, odds ratios for bleeding and AKI were not established. Conclusions: Patients positive for COVID-19 within 12 weeks of metastasis-related surgery face heightened postoperative complications, particularly when positivity is within 0–2 weeks of surgery. Additionally, a CCI score >3 further augments this risk, emphasizing the need for meticulous perioperative management and strategic patient selection in the era of COVID-19. |
| format | Article |
| id | doaj-art-1a3e912307aa4f98a6c5a9c8d7a0803f |
| institution | DOAJ |
| issn | 2773-157X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj-art-1a3e912307aa4f98a6c5a9c8d7a0803f2025-08-20T03:21:27ZengElsevierJournal of Orthopaedic Reports2773-157X2025-04-014110055110.1016/j.jorep.2025.100551Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgeryBeshoy Gabriel0Henry Hoang1En Chang2Justin P. Chan3California University of Science and Medicine, 1501 Violet St., Colton, CA, 92324, USADepartment of Orthopedics, University of California Irvine, Irvine, CA, USACalifornia University of Science and Medicine, 1501 Violet St., Colton, CA, 92324, USADepartment of Orthopedics, University of California Irvine, Irvine, CA, USA; Corresponding author.Objective: To elucidate the effects of COVID-19 positivity within 12 weeks preceding metastasis-related surgical procedures on postoperative complications. Methods: We retrospectively analyzed 20,104,963 patients, of which 109,127 underwent surgery for metastatic processes. Patients were categorized based on COVID-19 status within 12 weeks of surgery: positive (1.49 %) and negative (98.51 %). Variables assessed included demographic data, body mass index (BMI), Charlson Comorbidity Index (CCI) scores, and various postoperative complications, such as venous thromboembolism (VTE), 30-day and 365-day all-cause mortality. Results: The COVID-19 positive cohort exhibited a significantly higher BMI (32.41 ± 8.14 vs. 33.43 ± 7.56, p < 0.001) and CCI score (2.94 ± 3.06 vs. 2.67 ± 2.89, p < 0.001). Additionally, they demonstrated elevated rates of VTE (2.64 % vs. 1.36 %), 30-day mortality (1.65 % vs. 0.39 %), and 365-day mortality (5.71 % vs. 2.02 %). Adjusted multivariate logistic regression highlighted COVID-19 positivity within 0–2 weeks of surgery and CCI >3 as significant predictors of VTE, 30-day, and 365-day mortality. Adjusted odds ratios associated with recent COVID-19 positivity for VTE, sepsis, surgical site infection, 30-day mortality, and 365-day mortality were 2.69, 1.74, 0.98, 5.49, and 4.27, respectively. For CCI>3, the respective odds ratios were 2.10, 5.03, 1.89, 6.33, and 9.04. Owing to limited events, odds ratios for bleeding and AKI were not established. Conclusions: Patients positive for COVID-19 within 12 weeks of metastasis-related surgery face heightened postoperative complications, particularly when positivity is within 0–2 weeks of surgery. Additionally, a CCI score >3 further augments this risk, emphasizing the need for meticulous perioperative management and strategic patient selection in the era of COVID-19.http://www.sciencedirect.com/science/article/pii/S2773157X25000037Orthopedic oncologyCOVID-19 complicationsMetastatic bone diseaseVenous thromboembolism |
| spellingShingle | Beshoy Gabriel Henry Hoang En Chang Justin P. Chan Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery Journal of Orthopaedic Reports Orthopedic oncology COVID-19 complications Metastatic bone disease Venous thromboembolism |
| title | Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery |
| title_full | Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery |
| title_fullStr | Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery |
| title_full_unstemmed | Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery |
| title_short | Navigating the pandemic operating room: How COVID-19 infection timing affects complications in orthopedic oncologic surgery |
| title_sort | navigating the pandemic operating room how covid 19 infection timing affects complications in orthopedic oncologic surgery |
| topic | Orthopedic oncology COVID-19 complications Metastatic bone disease Venous thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X25000037 |
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