Incidence of Postoperative Pulmonary Complications in Patients with Prior COVID-19 Infection: A Lebanese Prospective Cohort Study

Background Postoperative pulmonary complications (PPCs) remain a major determinant of morbidity after noncardiac surgery. Whether prior SARS-CoV-2 infection independently heightens PPC risk in the contemporary, highly vaccinated, Omicron-Era population is uncertain. Methods We performed a prospective observational cohort study at a tertiary center in Beirut (Dec 2021–Dec 2022). Adult surgical patients with previous PCR-confirmed COVID-19 (COVID-19 group) were compared with COVID-19-naïve controls. The exclusion criteria included current COVID-19 infection, recent surgery, minor procedures, and ASA V–VI status. Detailed perioperative variables, ARISCAT scores, and COVID-19-specific metrics were collected. The primary endpoint was any PPC within 7 days; the secondary endpoints were individual pulmonary events, length of stay (LOS), postoperative oxygen duration, and 30-day readmission. Propensity-matched and multiple-imputed analyses addressed confounding factors and missing data. Results Among 186 analyzed patients (77 COVID-19 patients and 109 controls), the mean infection-to-surgery interval was 13.9 ± 10.2 months. The overall PPC incidence was 8.65% (16/186). PPC rates did not differ between the COVID-19 and control groups (10.4% vs 7.3%; χ² p = 0.6). No significant between-group differences were detected for respiratory failure, atelectasis, hypoxemia, unplanned ICU admission, or postoperative fever (all p > 0.40). The median LOS was 2 vs 3 days (COVID-19 patients vs controls; p = 0.082). Propensity matching and imputation of missing values yielded similar findings. Within the COVID-19 cohort, infection severity, vaccination dose, and time from infection to surgery were not correlated with PPCs, LOS, or oxygen requirements. Conclusions In a predominantly vaccinated population undergoing surgery after SARS-CoV-2 infection, prior COVID-19 did not increase early postoperative pulmonary morbidity. These data support individualized rather than blanket surgical delay policies for patients with remote COVID-19 infection.