# Does coronavirus disease 2019 history alone increase the risk of postoperative pulmonary complications after surgery? Prospective observational study using serology assessment

## TL;DR

This study found that having a history of mild or no symptoms from COVID-19 does not increase the risk of lung complications after surgery.

## Contribution

The study is novel in using serology to assess undetected prior SARS-CoV-2 infections and comparing postoperative pulmonary complication risks.

## Key findings

- Patients with a history of mild or no symptoms from COVID-19 did not have a higher risk of postoperative pulmonary complications.
- The risk of complications was similar between groups with and without a history of COVID-19 (24.0% vs. 26.0%).
- Excluded seropositive patients also had a 27.3% incidence of complications.

## Abstract

Concern exists about the increasing risk of postoperative pulmonary complications in patients with a history of coronavirus disease 2019 (COVID-19).

We conducted a prospective observational study that compared the incidence of postoperative pulmonary complications in patients with and without a history of COVID-19.

From August 2022 to November 2022, 244 adult patients undergoing major non-cardiac surgery were enrolled and allocated either to history or no history of COVID-19 groups. For patients without a history of confirming COVID-19 diagnosis, we tested immunoglobulin G to nucleocapsid antigen of SARS-CoV-2 for serology assessment to identify undetected infection. We compared the incidence of postoperative pulmonary complications, defined as a composite of atelectasis, pleural effusion, pulmonary edema, pneumonia, aspiration pneumonitis, and the need for additional oxygen therapy according to a COVID-19 history.

After excluding 44 patients without a COVID-19 history who were detected as seropositive, 200 patients were finally enrolled in this study, 100 in each group. All subjects with a COVID-19 history experienced no or mild symptoms during infection. The risk of postoperative pulmonary complications was not significantly different between the groups according to the history of COVID-19 (24.0% vs. 26.0%; odds ratio, 0.99; 95% confidence interval, 0.71–1.37; P-value, 0.92). The incidence of postoperative pulmonary complications was also similar (27.3%) in excluded patients owing to being seropositive.

Our study showed patients with a history of no or mild symptomatic COVID-19 did not show an increased risk of PPCs compared to those without a COVID-19 history. Additional precautions may not be needed to prevent PPCs in those patients.