COVID-19 Diagnosis Within 6 Weeks of Arthroscopic Knee Surgery Leads to Higher Risk for Postoperative 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 Postoperative 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, California, USA.
² Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA. Electronic address: [email protected].

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

Abstract

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

Methods: PearlDiver Mariner 165 database was queried for patients undergoing knee arthroscopy between 2010 and 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 postoperative 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 before surgery (7,858) had an overall higher incidence of VTE (1.72%) compared to patients without a preoperative COVID-19 diagnosis (0.81%) (P < .001). There was no difference in VTE incidence among patients with a preoperative COVID-19 diagnosis undergoing knee arthroscopy in the pre- and post-COVID-19 vaccination eras (odds ratio, 0.82; 95% CI, 0.51-1.31; P = .48). Multivariate regression accounting for covariates showed that patients with a preoperative COVID-19 diagnosis within 6 weeks before arthroscopy had significantly increased odds of experiencing postoperative VTE (odds ratio, 1.68; 95% CI, 1.09-2.45; P = .012). There was no significant difference in VTE risk among patients with a preoperative COVID-19 diagnosis between 6 and 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: Level III, retrospective case control study.