100. Increased risk for venous thromboembolic events in patients undergoing lumbar spinal fusion within two weeks of COVID-19 infection

COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. The purpose of this study is to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection. Retrospective. The National COVID Cohort Collaborative (N3C), a database of 17.4 million persons with 6.9 million COVID-19 cases. It is the largest multicenter cohort of COVID-19 cases and controls nationwide. Venous thromboembolic events, sepsis, surgical site infection, acute kidney injury, 30-day mortality, and 1-year mortality. We queried the N3C database for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within three time periods: 0-2 weeks, 2-6 weeks, or 6-12 weeks prior to surgery. All analyses were performed in the N3C Data Enclave Palantir platform. A total of 39,594 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58 to 3.32), sepsis (OR 1.56, 95% CI 1.03 to 2.36), 30-day mortality (OR 5.55, 95% CI 3.53 to 8.71), and one-year mortality (OR 2.70, 95% CI 1.91 to 3.82) compared to patients who did not have a positive COVID test during the 90 days prior to surgery. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. Patients undergoing lumbar spinal fusion surgery within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone nonurgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients. This abstract does not discuss or include any applicable devices or drugs.