tetano
Editor, Senior Moderator
BMJ Open
. 2026 Mar 18;16(3):e110131.
doi: 10.1136/bmjopen-2025-110131.
Association between preoperative COVID-19 and major postoperative pulmonary complications: a multicentre observational cohort study in China
Tian Wang[SUP] #[/SUP][SUP] 1 [/SUP], Yanhan Lyu[SUP] #[/SUP][SUP] 1 [/SUP], Hong Zhang[SUP] #[/SUP][SUP] 2 [/SUP], Lei Zhao[SUP] 3 [/SUP], Yaqing Wu[SUP] 4 [/SUP], Qingbian Ma[SUP] 5 [/SUP], Dongsheng Yang[SUP] 1 [/SUP], Rui Zhang[SUP] 1 [/SUP], Zhengqian Li[SUP] 1 [/SUP], Yongzheng Han[SUP] 1 [/SUP], Chang Liu[SUP] 1 [/SUP], Xiangyang Guo[SUP] 1 [/SUP], Yi Feng[SUP] 4 [/SUP], Dongxin Wang[SUP] 6 [/SUP], Tianlong Wang[SUP] 7 [/SUP], Min Li[SUP] 8 [/SUP]
Affiliations
Objective: To evaluate the relationship between preoperative COVID-19 infection and major postoperative pulmonary complications (PPC) risk after major elective surgeries during the Omicron wave.
Design: A multicentre, prospective, observational cohort study.
Setting: Four tertiary medical centres in Beijing, China.
Participants: All adult patients who underwent major elective surgeries under general anaesthesia from 30 December 2022 to 18 May 2023 were screened for eligibility. A total of 3211 patients were included.
Primary and secondary measures: The primary outcome was 30-day major PPC, defined as pneumonia, acute respiratory distress syndrome or unexpected postoperative ventilation. The secondary outcomes included length of hospital stay (LOS), reoperation and mortality.
Results: Major PPC occurred in 3.5% of patients with preoperative COVID-19 and 3.3% of those without. Inverse probability of treatment weighting-adjusted analysis showed no significant association between preoperative COVID-19 within 12 weeks and PPC risk (adjusted OR, 0.89; 95% CI 0.69 to 1.13). However, multivariable analysis revealed that COVID-19 infection within 3 weeks was independently associated with an increased PPC risk (OR, 3.44; 95% CI 1.37 to 8.68). Cardiothoracic surgery (OR, 12.47; 95% CI 8.11 to 19.17) and longer duration of surgery (OR, 1.24 per hour; 95% CI 1.13 to 1.37) were significant risk factors. In the cardiothoracic subgroup, PPC risk was significantly elevated within 7 weeks of infection. No significant differences were observed in LOS, reoperation rates or mortality between patients with and without preoperative COVID-19 infection.
Conclusions: Preoperative COVID-19 infection within 12 weeks was not associated with an increased overall risk of major PPC during the Omicron wave. Although very short infection-to-surgery intervals and cardiothoracic surgery showed exploratory signals of higher risk, these findings should be interpreted cautiously and support an individualised approach to perioperative risk assessment.
Trial registration number: ChiCTR2200067250.
Keywords: Adult anaesthesia; Adult surgery; Clinical Decision-Making.
. 2026 Mar 18;16(3):e110131.
doi: 10.1136/bmjopen-2025-110131.
Association between preoperative COVID-19 and major postoperative pulmonary complications: a multicentre observational cohort study in China
Tian Wang[SUP] #[/SUP][SUP] 1 [/SUP], Yanhan Lyu[SUP] #[/SUP][SUP] 1 [/SUP], Hong Zhang[SUP] #[/SUP][SUP] 2 [/SUP], Lei Zhao[SUP] 3 [/SUP], Yaqing Wu[SUP] 4 [/SUP], Qingbian Ma[SUP] 5 [/SUP], Dongsheng Yang[SUP] 1 [/SUP], Rui Zhang[SUP] 1 [/SUP], Zhengqian Li[SUP] 1 [/SUP], Yongzheng Han[SUP] 1 [/SUP], Chang Liu[SUP] 1 [/SUP], Xiangyang Guo[SUP] 1 [/SUP], Yi Feng[SUP] 4 [/SUP], Dongxin Wang[SUP] 6 [/SUP], Tianlong Wang[SUP] 7 [/SUP], Min Li[SUP] 8 [/SUP]
Affiliations
- PMID: 41857832
- DOI: 10.1136/bmjopen-2025-110131
Objective: To evaluate the relationship between preoperative COVID-19 infection and major postoperative pulmonary complications (PPC) risk after major elective surgeries during the Omicron wave.
Design: A multicentre, prospective, observational cohort study.
Setting: Four tertiary medical centres in Beijing, China.
Participants: All adult patients who underwent major elective surgeries under general anaesthesia from 30 December 2022 to 18 May 2023 were screened for eligibility. A total of 3211 patients were included.
Primary and secondary measures: The primary outcome was 30-day major PPC, defined as pneumonia, acute respiratory distress syndrome or unexpected postoperative ventilation. The secondary outcomes included length of hospital stay (LOS), reoperation and mortality.
Results: Major PPC occurred in 3.5% of patients with preoperative COVID-19 and 3.3% of those without. Inverse probability of treatment weighting-adjusted analysis showed no significant association between preoperative COVID-19 within 12 weeks and PPC risk (adjusted OR, 0.89; 95% CI 0.69 to 1.13). However, multivariable analysis revealed that COVID-19 infection within 3 weeks was independently associated with an increased PPC risk (OR, 3.44; 95% CI 1.37 to 8.68). Cardiothoracic surgery (OR, 12.47; 95% CI 8.11 to 19.17) and longer duration of surgery (OR, 1.24 per hour; 95% CI 1.13 to 1.37) were significant risk factors. In the cardiothoracic subgroup, PPC risk was significantly elevated within 7 weeks of infection. No significant differences were observed in LOS, reoperation rates or mortality between patients with and without preoperative COVID-19 infection.
Conclusions: Preoperative COVID-19 infection within 12 weeks was not associated with an increased overall risk of major PPC during the Omicron wave. Although very short infection-to-surgery intervals and cardiothoracic surgery showed exploratory signals of higher risk, these findings should be interpreted cautiously and support an individualised approach to perioperative risk assessment.
Trial registration number: ChiCTR2200067250.
Keywords: Adult anaesthesia; Adult surgery; Clinical Decision-Making.