Timing of surgery for spinal deformity patients during the COVID‑19 pandemic: experience from a prospective cohort at Peking Union Medical College Hospital

The purpose of this study was to explore the optimal timing and associated risks of spinal deformity surgery during the COVID‑19 pandemic.

All consecutive surgical cases for spinal deformity between November 2022 and April 2023 were included. The population was divided into several categories according to the time from diagnosis of SARS-CoV-2 infection to the day of surgery: without infection (pre-COVID-19), infection at 0 to 4 weeks (peri-COVID-19), infection at 4 to 8 weeks (early post-COVID-19), and infection over 8 weeks (late post-COVID-19). The primary outcome and secondary outcomes were 90-day complication rate and total hospital stay. Postoperative complications and total hospital stay were analyzed using logistic regression and linear regression models, and we simultaneously showed the results from the crude model, minimally adjusted model and fully adjusted model. In addition, we performed various sensitivity analyses.

A total of 60 consecutive patients were enrolled. The overall complication rate at 90 days postoperatively was 41.6% (25 of 60 patients), and the total hospital stay for all patients was (10.1 ± 3.5) days. In the fully adjusted model, compared with pre-COVID-19 patients, peri-COVID-19 patients had a 5.1-fold increased risk of postoperative complications (OR = 6.1, 95% CI 1.1–31.9, P = 0.030), early post-COVID-19 patients and late post-COVID-19 patients were at essentially equal risk. In terms of total hospital stay, compared with patients not infected with SARS-CoV-2, peri-COVID-19 patients had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3–5.8, P = 0.032), early post-COVID-19 patients also had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3–6.0, P = 0.032), and late post-COVID-19 patients had the similar hospital stay (ꞵ = -0.4, 95%CI -2.9–2.1, P = 0.741). Sensitivity analysis showed that the conclusions were robust.

With careful preoperative screening of patients for COVID-19, spinal deformity surgery can proceed safely during the epidemic. We recommend that spinal deformity surgery be delayed in patients with COVID-19 until 8 weeks after SARS-CoV-2 infection.