Postoperative cardiopulmonary complications in children with preoperative Omicron SARS-CoV-2 variants infection: a single-center retrospective cohort study

The purpose of this study was to investigate: (1) the incidence of cardiopulmonary complications within 30 days after surgery in pediatric patients with preoperative Omicron variants infection, (2) the mortality, and (3) their possible risk factors. This retrospective study included a consecutive patient cohort who underwent elective non-cardiac surgery for any indication in the Pediatric Department of our hospital between November 2022 and February 2023. Cardiopulmonary complications and mortality within 30 days after surgery were compared between patients with pre-operative SARS-CoV-2 infection (Omicron variants infected group) and those without infection (the uninfected group) within 90-day before the surgery. The study evaluated the demographic data and related clinical factors of complications by analyzing their clinical records. Our study included 502 patients, of which 194 (38.65%) had a pre-operative Omicron variants diagnosis. The mean duration between definite Omicron variants infection and surgery was 31.28 ± 10.19 days. In our study, the incidence of pulmonary complications was 1.59% (8/502 patients), no cardiac complication or mortality was found in the 30-day postoperative follow-up. The Omicron variants infected group had a significantly higher incidence of complications (7/194, 3.61%) compared to the uninfected group (1/308, 0.32%) (p = 0.006). After adjusted for other factors, it was found that the Omicron variants infection within 4 weeks before surgery (OR = 17.84, 95% CI: 1.25-255.35, p = 0.034), higher BMI (OR = 1.26, 95% CI: 1.02–1.55, p = 0.034), ASA physical status grade III-V (OR = 17.35, 95% CI: 1.19–253.80, p = 0.037), and abnormal preoperative chest radiograph (OR = 60.07, 95% CI: 1.92-1878.21, p = 0.020) were independent risk factors for postoperative pulmonary complications in patients within 30 days after the surgery. Omicron infection may heighten the risk of pulmonary complications in children undergoing elective non-cardiac surgery. It is advisable to schedule elective surgery at least 4 weeks after infection of Omicron variants.