https://links.lww.com/SLA/E37

(1)

Supplemental Table 1: Perioperative Complications and Corresponding International Classification of Diseases (ICD) Codes

Perioperative Complications ICD-10 Codes

Arrhythmia I49

Deep Vein Thrombosis I82 except for I82.5 & I82.7

Pulmonary Embolism I26

Pneumonia J12-J18

Respiratory Failure J96.0, J96.2, J96.9, J80, R09.2, J95.82

Renal Failure N17

Sepsis A41

Urinary Tract Infection N39.0, N99.89

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Supplemental Table 2: Most Common Procedure Categories, by Covid-19 Surgery Groups

Early Post-Covid-19

(Surgery 0 to 4 Weeks After Covid-19)

Mid Post-Covid-19 (Surgery 4 to 8 Weeks After Covid-19)

Late Post-Covid-19 (Surgery at Least 8 Weeks

After Covid-19)

Pre-Covid-19 (Covid-19 After Surgery)

Category % Category % Category % Category

Other OR therapeutic

procedures on bone

11.9% Other OR therapeutic

procedures on bone 12.0%

procedures on bone

10.8% Other OR therapeutic procedures on bone Cholecystectomy

and common duct exploration

4.8% Cholecystectomy and

common duct exploration 7.3%

Cholecystectomy and common duct exploration

5.6% Arthroplasty knee Other therapeutic

procedures on muscles and tendons

4.8%

Other therapeutic procedures on muscles and tendons

3.9% Arthroplasty knee 5.5%

Cholecystectomy and common duct

exploration Endoscopy and

endoscopic biopsy of the urinary tract

3.7% Skin graft 3.1%

4.1%

Arthroplasty knee 3.1%

Endoscopy and

endoscopic biopsy of the urinary tract

3.0%

Inguinal and femoral hernia repair

3.9% Inguinal and femoral hernia repair

Excision of skin

lesion 3.1% Arthroplasty knee 2.9% Skin graft 3.6% Skin graft

Lumpectomy, quadrantectomy of breast

3.0% Inguinal and femoral

hernia repair 2.8% Other hernia repair 3.3% Hip replacement, total and partial

Other fracture and dislocation procedure

3.0% Hip replacement, total

and partial 2.8%

Endoscopy and endoscopic biopsy of the urinary tract

3.1%

Endoscopy and endoscopic biopsy of the urinary tract Inguinal and

femoral hernia repair

2.9% Excision of skin lesion 2.3% Hip replacement,

total and partial 2.8%

Other OR therapeutic procedures on skin and breast

Colorectal

resection 2.4% Lumpectomy,

quadrantectomy of breast 2.3%

procedures on skin and breast

2.7% Other hernia repair

Mastectomy 2.2%

procedures on skin and 2.3% Excision of skin

lesion 2.4% Excision of skin lesion

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total and partial lithotripsy, urinary quadrantectomy of

breast cartilage of knee

Extracorporeal

lithotripsy, urinary 2.0% Other hernia repair 1.9%

Other therapeutic procedures, hemic and lymphatic system

1.6%

Debridement of wound, infection or burn

Nonoperative urinary system measurements

2.0% Debridement of wound,

infection or burn 1.9%

Debridement of wound, infection or burn

1.5%

Other therapeutic procedures, hemic and lymphatic system Other therapeutic

procedures, hemic and lymphatic system

1.8% Other diagnostic procedures, female organs

1.8% Laparoscopy 1.5% Partial excision bone

Treatment, fracture or dislocation of radius and ulna

1.7% Ureteral catheterization 1.7% Partial excision

bone 1.5% Laparoscopy

Hysterectomy, abdominal and vaginal

1.6% Other fracture and

dislocation procedure 1.6%

procedures on nose, mouth and pharynx

1.5% Gastric bypass and volume reduction Abortion

(termination of pregnancy)

1.6% Partial excision bone 1.5% Extracorporeal

lithotripsy, urinary 1.4%

Other OR therapeutic procedures of urinary tract

Other hernia repair 1.4% Colorectal resection 1.4%

Creation, revision and removal of arteriovenous fistula or vessel-to- vessel cannula for dialysis

1.4%

Creation, revision and removal of

arteriovenous fistula or vessel-to-vessel cannula for dialysis

Current Procedural Terminology codes for surgical cases were classified using the Clinical

Classification Software (CCS) for Services and Procedures

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Supplemental Table 3: Rates of Perioperative Complications and Returns to Care

All Elective Surgeries Fully

Vaccinated

Not Fully Vaccinated

228,913 84,350 144,563

Any Post-Operative Complication 11,427 (5.0%) 4,209 (5.0%) 7,218 (5.0%)

Arrhythmia 1,611 (0.7%) 655 (0.8%) 956 (0.7%)

Deep Vein Thrombosis 1,185 (0.5%) 419 (0.5%) 766 (0.5%)

Pulmonary Embolism 616 (0.3%) 220 (0.3%) 396 (0.3%)

Pneumonia 957 (0.4%) 334 (0.4%) 623 (0.4%)

Respiratory Failure 37 (0.0%) 10 (0.0%) 27 (0.0%)

Renal Failure 2,502 (1.1%) 861 (1.0%) 1,641 (1.1%)

Sepsis 1,737 (0.8%) 608 (0.7%) 1,129 (0.8%)

Urinary Tract Infection 5,407 (2.4%) 2,062 (2.4%) 3,345 (2.3%)

Non-Elective Hospitalization 7,195 (3.1%) 2,685 (3.2%) 4,510 (3.1%) Emergency Department Treat-and-Release 19,243 (8.4%) 6,811 (8.1%) 12,432 (8.6%)

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Supplemental Table 4: Adjusted Risks of Perioperative Complication of Covid-19 Surgery Groups, Limited to Surgeries Performed After January 2021

Relativ e Risk

Lower Bound of One-Sided

95%

Confidence Interval

P-value

Fully Vaccinated

Early Post-Covid-19 (Surgery 0

to 4 Weeks After Covid-19) 0.66 0.35 1.00

Mid Post-Covid-19 (Surgery 4 to

8 Weeks After Covid-19) 0.72 0.37 1.00

Late Post-Covid-19 (Surgery at

Least 8 Weeks After Covid-19) 0.98 0.71 0.92

Pre-Covid-19 (Covid-19 After

Surgery) Reference Group

Not Fully Vaccinated

Early Post-Covid-19 (Surgery 0

to 4 Weeks After Covid-19) 1.83 1.25 0.02

Mid Post-Covid-19 (Surgery 4 to

8 Weeks After Covid-19) 1.01 0.68 0.83

Late Post-Covid-19 (Surgery at

Least 8 Weeks After Covid-19) 1.02 0.86 0.79

Pre-Covid-19 (Covid-19 After

Surgery) Reference Group

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Supplemental Table 5: Comparison of Adjusted Risk of Perioperative Complications of Elective Surgeries Performed After Covid-19 Infection with Elective Surgeries Without Covid-19 History, by Covid-19 Vaccination Status and Intended Post- Operative Disposition

Outpatient Inpatient

N

^Relative Risk

Lower Bound of One-Sided

95%

P-value

N

^Relative Risk

95%

P-value

Fully Vaccinated

Early Post-Covid-19 (Surgery 0 to 4 Weeks After

Covid-19)

337 0.75 0.34 0.83 55 0.45 0.10 0.53

Mid Post-Covid-19 (Surgery 4 to 8 Weeks After

Covid-19)

318 0.78 0.35 0.89 47 0.58 0.10 0.90

Late Post-Covid-19 (Surgery at Least 8 Weeks After

Covid-19)

1,103 1.06 0.72 0.99 107 0.67 0.26 0.72

Pre-Covid-19 (Covid-19 After Surgery)

3,461 Reference Group 455 Reference Group

Not Fully Vaccinated

Early Post-Covid-19 (Surgery 0 to 4 Weeks After

Covid-19)

332 1.43 0.81 0.38 41 1.97 0.75 0.28

Mid Post-Covid-19 (Surgery 4 to 8 Weeks After

Covid-19)

531 1.02 0.62 1.00 65 0.41 0.07 0.60

Late Post-Covid-19 (Surgery at Least 8 Weeks After

Covid-19)

7,118 0.81 0.66 0.04 842 1.09 0.74 0.96

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Supplemental Table 6: Comparison of Adjusted Risk of Perioperative Complications of Elective Surgeries Performed After Covid-19 Infection with Elective Surgeries Without Covid-19 History, by Covid-19 Vaccination Status and Mode of Anesthesia

N

All General Anesthesia No General Anesthesia

Relative Risk

95%

P-value Relative Risk

95%

P-value Relative Risk

95%

P- value

Fully Vaccinated Early Post-Covid-19 (Surgery 0 to 4 Weeks After Covid-19)

392 0.76 0.41 1.00 0.81 0.41 1.00 0.55 0.11 1.00

Mid Post-Covid-19 (Surgery 4 to 8 Weeks After Covid-19)

365 0.82 0.43 0.99 0.63 0.27 1.00 1.50 0.55 0.56

Late Post-Covid-19 (Surgery at Least 8 Weeks After Covid-19)

1,210 1.12 0.84 0.56 1.15 0.83 0.54 1.01 0.56 0.92

No Covid-19 78,467 Reference Group

Not Fully Vaccinated Early Post-Covid-19 (Surgery 0 to 4 Weeks After Covid-19)

373 1.70 1.10 0.01 2.02 1.28 <0.001 0.59 0.12 1.00

Mid Post-Covid-19 (Surgery 4 to 8 Weeks After Covid-19)

596 1.04 0.68 0.88 0.95 0.59 0.96 1.48 0.59 0.52

Late Post-Covid-19 (Surgery at Least 8 Weeks After Covid-19)

7,960 0.95 0.82 1.00 0.98 0.83 0.98 0.84 0.61 1.00

No Covid-19 120,130 Reference Group