SARS-CoV-2 (COVID-19) has infected over 100,000,000 million people in the United States
(US). During the "first wave" in the US, medical facilities were advised to limit
operative exposure, stratify operative cases by both risk and urgency and cancel elective
procedures.

With over 60% of the US population considered fully vaccinated as of May of 2020,
elective surgeries resumed amid periodic outbreaks allowing for continued insight into
the impact of COVID-19 on the postoperative recovery process. However, relative to the
volume of data on active infections, there is far less concerning the sequelae of
previous infections. Therefore, the purpose of this study is to analyze a safety net
hospital's experience regarding postoperative complications in patients that underwent
surgical procedures requiring general anesthesia within a year of testing positive for
COVID-19.

This is a retrospective study from a high-volume tertiary referral center and safety net
hospital in Bakersfield, California. After approval by the Institutional Review Board,
the electronic health record (EHR) was queried for all positive COVID-19 patients that
underwent a surgical procedure of any kind requiring general anesthesia from 5 May 2020
to 31 December 2022. A total of 7,696 patients met inclusion criteria. 420 tested
positive for COVID-19. Participants were subdivided into three study groups defined as
symptomatic COVID-19 infection, asymptomatic COVID-19 infection, and COVID-19 negative
control group.

Individual chart review allowed for subclassification based on symptomatology, admission
status, length of admission, American Society of Anesthesiologist Physical Status
Classification System (ASA), qSOFA and GCS rating along with COVID-19 and surgical
complications Patients were required to have a COVID-19 diagnosis within one year of
surgery. Categorical variables assessed in participants included age, sex, BMI, race, ICU
or DOU stay. Post-operative complications assessed for included hospital length of stay,
30-day mortality, 30-day readmission, cardiac arrest, septic shock, acute kidney injury,
acute respiratory distress syndrome, deep vein, thrombosis, pulmonary embolism,
respiratory failure and pneumonia.

Statistical analysis was completed by the institution's statistician. Using Fisher
extract, ANOVA, univariate and multivariate logistic regression analyses, odds ratios and
p-values were obtained to evaluate for statistically significant correlations between
categorical variables.