Effect of COVID-19 and its vaccines on surgical and postsurgical mortality, ICU admission and 90-day readmission for elective surgical procedures in a United States veteran population

BACKGROUND: We investigated how COVID-19 infection and vaccination impact elective surgical outcomes. METHODS: We retrospectively compared pre-pandemic (P) veterans to those with COVID (C) more than three weeks preoperatively or no COVID (NC) history after carotid endarterectomy, CABG, hip replacement, or colectomy. Subgroup analysis considered vaccination. Age and sex propensity matching, and conditional logistic regression analyzed one-year-mortality, 90-day-readmission, and ICU requirements among 519 C, 1038 NC, and 2076 P, culled from 61,641 veterans. RESULTS: NC, C, and P had similar ICU requirements and mortality, although NC required fewer readmissions. However, NC immunized at least once were readmitted and died less commonly than C who received at least one immunization. CONCLUSIONS: SARS-CoV-2 history increased readmission without affecting ICU requirement or mortality. Further studies should evaluate whether the worse outcomes in postoperative patients with histories of both COVID infection and one vaccination reflect the effects of incomplete vaccination or dataset limitations.