Previous Coronavirus Disease-2019 Infection and Lung Mechanics in Surgical Patients: A Hospital Registry Study

BACKGROUND:Long-term pulmonary complications have been reported after a coronavirus disease-2019 (COVID-19). We hypothesized that a history of COVID-19 is associated with a measurable decrease in baseline respiratory system compliance in patients undergoing general anesthesia. METHODS:In this hospital registry study, we included adult patients undergoing general anesthesia between January 2020 and March 2022 at a tertiary health care network in Massachusetts. We excluded patients with an American Society of Anesthesiologists physical status >IV, laryngoscopic surgeries, and patients who arrived intubated. The primary exposure was a history of COVID-19. The primary outcome was baseline respiratory system compliance (mL/cmH(2)O). Effects of severity of infection, surges (Alpha(1), Alpha(2), Delta, and Omicron), patient demographics, and time between infection and assessment of compliance were investigated. RESULTS:A total of 19,921 patients were included. Approximately 1386 (7.0%) patients had a history of COVID-19. A history of COVID-19 at any time before surgery was associated with a measurably lower baseline respiratory system compliance (ratio of means(adj) = 0.96; 95% confidence interval [CI], 0.94-0.97; P < .001; adjusted compliance difference: -1.6 mL/cmH(2)O). The association was more pronounced in patients with a severe form of COVID-19 (ratio of means(adj) = 0.95; 95% CI, 0.90-0.99; P = .02, adjusted compliance difference: -2 mL/cmH(2)O). Alpha(1), Alpha(2), and Delta surges, but not Omicron, led to a lower baseline respiratory system compliance (P < .001, P = .02, and P < .001). The Delta surge effect was magnified in Hispanic ethnicity (P-for-interaction = 0.003; ratio of means(adj) = 0.83; 95% CI, 0.74-0.93; P = .001; adjusted compliance difference: -4.6 mL/cmH(2)O). CONCLUSIONS:A history of COVID-19 infection during Alpha1, Alpha2, and Delta surges was associated with a measurably lower baseline respiratory system compliance.