COVID-19 Diagnosis within 6 Weeks of Arthroscopic Knee Surgery Leads to Higher Risk for Post-operative Venous Thromboembolism

Kevin C Wang; Sophia Wang; Juan Serna; Favian Su; Ryan T Halvorson; Drew A Lansdown; C Benjamin Ma; Alan L Zhang

doi:10.1016/j.arthro.2024.12.013

COVID-19 Diagnosis within 6 Weeks of Arthroscopic Knee Surgery Leads to Higher Risk for Post-operative Venous Thromboembolism

Arthroscopy. 2024 Dec 19:S0749-8063(24)01076-4. doi: 10.1016/j.arthro.2024.12.013. Online ahead of print.

Authors

Kevin C Wang¹, Sophia Wang¹, Juan Serna¹, Favian Su¹, Ryan T Halvorson¹, Drew A Lansdown¹, C Benjamin Ma¹, Alan L Zhang²

Affiliations

¹ Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA.
² Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA. Electronic address: [email protected].

PMID: 39709106
DOI: 10.1016/j.arthro.2024.12.013

Abstract

Purpose: To determine if pre-operative infection with COVID-19 increased risk for post-operative venous thromboembolism (VTE) in patients undergoing arthroscopic knee surgery..

Methods: PearlDiver Mariner 165 database was queried for patients undergoing knee arthroscopy between 2010 through October, 2022. Patients were categorized by history of COVID-19 diagnosis and timing in relation to surgery. Multivariate logistic regression was performed to isolate the effect of COVID-19 diagnosis on post-operative VTE rates. Covariates included age, obesity, smoking, oral contraceptive pill use, hypertension, coronary artery disease, congestive heart failure, malignancy, renal disease and diabetes.

Results: A total of 954,294 patients met inclusion criteria and 7,637 patients experienced VTE, including deep vein thrombosis (n = 5,830, 0.61%) and pulmonary embolism (n=2,790, 0.29%). Patients with a COVID-19 diagnosis prior to surgery (7,858) had an overall higher incidence of VTE (1.72%) compared to patients without a pre-operative COVID-19 diagnosis (0.81%) (p < 0.001). There was no difference in VTE incidence amongst patients with a pre-operative COVID-19 diagnosis undergoing knee arthroscopy in the pre- and post-COVID-vaccination eras (OR 0.82, 95% CI = 0.51 - 1.31, p=0.48). Multivariate regression accounting for covariates showed that patients with a pre-operative COVID-19 diagnosis within 6 weeks before arthroscopy had significantly increased odds of experiencing post-operative VTE (OR 1.68, 95% CI 1.09-2.45, p=0.012). There was no significant difference in VTE risk between patients with a pre-operative COVID-19 diagnosis between 6-12 weeks before arthroscopy and more than 12 weeks before arthroscopy compared to those with no prior COVID-19 diagnosis.

Conclusions: COVID-19 diagnosis within 6 weeks preceding arthroscopic knee surgery leads to a significantly higher risk for postoperative VTE.

Level of evidence: III, retrospective case control study.