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

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; DROMIS-22 Study Group and the SFAR Research Network

doi:10.1016/j.eclinm.2023.101881

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

EClinicalMedicine. 2023 Apr:58:101881. doi: 10.1016/j.eclinm.2023.101881. Epub 2023 Mar 1.

Authors

Marc Garnier^{1

2}, Jean-Michel Constantin³, Raphaël Cinotti^{4

5}, Chafia Daoui⁶, Dimitri Margetis³, Grégory Destruhaut⁷, Cédric Cirenei⁸, Eric Noll⁹, Christophe Quesnel¹, Agnes Lecinq¹⁰, Sigismond Lasocki¹¹, Hélène Charbonneau¹², Stanislas Abrard¹³, Cyril Quemeneur^{3

14}, Bruno Pastene¹⁵, Nathanaël Lapidus¹⁶, Marc Leone¹⁵; DROMIS-22 Study Group and the SFAR Research Network

Collaborators

DROMIS-22 Study Group and the SFAR Research Network:
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

Affiliations

¹ Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 4 rue de la Chine, Paris 75020, France.
² CHU de Clermont-Ferrand, Université Clermont Auvergne, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 58 rue Montalembert, Clermont-Ferrand 63000, France.
³ Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital de la Pitié Salpêtrière, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 91boulevard de l'Hôpital, Paris 75013, France.
⁴ CHU Nantes, Nantes Université, Department of Anaesthesia and Critical Care, Hôtel Dieu, Nantes F-44000, France.
⁵ UMR 1246 SPHERE "MethodS in Patients-centered outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, Nantes 44200, France.
⁶ SFAR Research Network, Société Française d'Anesthésie Réanimation et médecine péri-opératoire (SFAR), 74 rue Raynouard, Paris 75016, France.
⁷ Clinique du Sport Bordeaux Mérignac, 4 rue Georges Négrevergne, Mérignac 33700, France.
⁸ Pôle d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Lille, Boulevard du Professeur Jules Leclerc, Lille Cedex 59037, France.
⁹ Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation-Médecine Périopératoire, 1 Avenue Molière, Strasbourg, France.
¹⁰ Université Paris-Saclay, APHP, Hôpital Antoine Béclère, Service d'Anesthésie, 157 rue de la Porte de Trivaux, Clamart 92140, France.
¹¹ Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitire d'Angers, 4 rue Larrey, Angers 49100, France.
¹² Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, 45 avenue de Lombez, BP27617, Toulouse Cedex 03 31076, France.
¹³ Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Place d'Arsonval, Lyon 69003, France.
¹⁴ Department of Anesthesiology, Clinique Drouot Sport, 37 rue Molitor, Paris 75016, France.
¹⁵ Aix Marseille Université, Assistance Publique-Hôpitaux Universitaire de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Chemin de Bourrely, Marseille 13015, France.
¹⁶ Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, Paris F75012, France.

Abstract

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).

Keywords: Acute respiratory failure; Anaesthesia; COVID-19; Perioperative risk; Postoperative pneumonia; Prognosis; Respiratory complications; Surgery.