Thrombotic Consequences of COVID-19 Infection on Microsurgical Reconstruction

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-08-29 DOI:10.1002/micr.31219

Sabrina H. Han, Kyle Ockerman, Matthew Kirchmier, Markos Mardourian, Jaimie Bryan, Elizabeth Cox, Harvey Chim, Lisa Spiguel, Arash Momeni, Sarah Sorice-Virk

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引用次数: 0

Abstract

Background

Evidence has shown increased morbidity and mortality for patients with COVID-19 infection within 7 weeks of surgery. However, no studies have specifically investigated the effects of COVID-19 in microsurgical outcomes. This study evaluated thrombotic and overall complications after free tissue transfer for a variety of indications in patients with and without previous COVID-19 infection.

Methods

A retrospective cohort study was performed in adult patients with or without a history of COVID-19 infection who underwent microsurgical reconstruction between 2017 and 2022. Patients with a history of COVID-19 infection were matched to controls based on age, gender, race, body mass index, history of diabetes, coronary artery disease, hypertension, Caprini score, tobacco use, and flap indication.

Results

From 2017 to 2022, 35 patients had a documented history of COVID-19. Matched case analysis determined a 4.8 times increased odds ratio of postoperative complications in the COVID-19 group compared with controls (p = 0.002). Significantly, more patients with COVID-19 experienced total or partial flap loss and anastomotic issues (COVID-19: 7/35, Control: 0/35; p < 0.001). There was no significant difference in incidence of VTE (COVID-19: 1/35, Control: 0/35; p = 0.493). Of note, 62.9% of the COVID-19 group were discharged on anticoagulants (versus 14.3% in the control group [p < 0.001]).

Conclusion

COVID-19 has dire, long-lasting effects on virtually every organ system, chief among them, the microcirculation. Further studies are needed to fully determine the extent and influence of COVID-19 on complex procedures such as free tissue transfer and how to optimize the screening, workup, and postoperative care to guard against the associated thrombotic consequences.

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COVID-19 感染对显微外科重建造成的血栓形成后果

背景有证据表明，手术后 7 周内感染 COVID-19 的患者发病率和死亡率会增加。然而，还没有研究专门调查过 COVID-19 对显微手术结果的影响。本研究评估了曾感染或未感染 COVID-19 的患者因各种适应症进行游离组织转移后的血栓形成和整体并发症。方法对 2017 年至 2022 年期间接受显微外科重建手术的有或无 COVID-19 感染史的成年患者进行了一项回顾性队列研究。根据年龄、性别、种族、体重指数、糖尿病史、冠心病史、高血压史、Caprini评分、吸烟史和皮瓣适应症，将有COVID-19感染史的患者与对照组进行配对。结果从2017年到2022年，35名患者有COVID-19病史记录。配对病例分析表明，与对照组相比，COVID-19 组术后并发症的几率增加了 4.8 倍（P = 0.002）。值得注意的是，更多的 COVID-19 患者出现了皮瓣全部或部分脱落以及吻合问题（COVID-19：7/35，对照组：0/35；p <0.001）。VTE 发生率无明显差异（COVID-19：1/35，对照组：0/35；P = 0.493）。值得注意的是，COVID-19 组 62.9% 的患者出院时服用了抗凝药物（对照组为 14.3% [p<0.001]）。结论 COVID-19 几乎对每个器官系统都有可怕而持久的影响，其中最主要的是微循环。要全面确定 COVID-19 对游离组织移植等复杂手术的影响程度，以及如何优化筛查、检查和术后护理以预防相关血栓后果，还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.