We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

中文翻译：

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术前隔离对择期手术后肺部并发症的影响：一项国际前瞻性队列研究

我们旨在确定在全球 SARS-CoV-2 大流行期间术前隔离对择期手术后肺部并发症的影响。我们对 2020 年 10 月接受择期手术的患者进行了一项国际前瞻性队列研究。隔离定义为手术前的一段时间，在此期间患者不离开家或接待来自家庭外的访客。主要结果是术后肺部并发症，在多变量模型中针对测量的混杂因素进行了调整。对主要结果进行了预定义的亚组分析。共有来自 114 个国家的 96,454 名患者被纳入，总体而言，26,948 名（27.9%）患者在手术前被隔离。1947 例 (2.0%) 患者记录了术后肺部并发症，其中 227 例 (11. 7%）与 SARS-CoV-2 感染有关。术前隔离的患者年龄较大，有更多的呼吸道合并症，并且更常见于 SARS-CoV-2 高发地区和高收入国家。尽管隔离患者和未隔离患者的术后肺部并发症的总体发生率相似（分别为 2.1% 和 2.0%），但隔离与调整后较高的术后肺部并发症发生率相关（调整后的 OR 1.20，95%CI 1.05 –1.36，p = 0.005）。敏感性分析显示，当患者按以下方式分类时，没有进一步的差异：术前检查；使用不含 COVID-19 的途径；或社区 SARS-CoV-2 流行率。术后肺部并发症的发生率随着隔离时间超过 3 天而增加，OR (95%CI) 为 4-7 天或 1 ≥ 8 天。25 (1.04–1.48), p = 0.015 和 1.31 (1.11–1.55), p = 0.001。择期手术前的隔离可能会增加术后肺部并发症的风险，但具有临床意义。较长时间的隔离显示术后肺部并发症的风险没有降低。这些发现对全球提供选择性外科护理具有重要意义。