Abstract
The global spread of coronavirus disease 2019 (COVID-19) has had a profound public health impact, particularly on perioperative management, rendering the optimization of timing for post-infection thoracic oncologic surgery a pressing clinical concern. This multicenter retrospective cohort study included adult patients who underwent elective video-assisted thoracic oncologic surgery in February 2023 with confirmed COVID-19 infection ≥ 4 weeks prior. A matched historical control cohort from February 2019 was used for comparison. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to adjust for confounders. Subgroup analyses were conducted based on clinical variables, and logistic regression was used to assess the association between infection-to-surgery interval and PPCs. A total of 846 patients were included. After PSM and IPTW, the incidence of PPCs remained comparable between the COVID-19 and no-COVID-19 groups (PSM: 26.1% vs. 31.8%, p = 0.784; IPTW: 28.0% vs. 29.7%, p = 0.615). No significant differences in PPC rates were observed across infection-to-surgery intervals (4–6, 6–8, and 8–12 weeks; p = 0.953). Prior COVID-19 infection was associated with higher postoperative WBC counts and lower lymphocyte levels, but not with increased PPCs risk. Smoking history was an independent predictor of PPCs (OR: 2.503, p = 0.005), while infection timing was not. Thoracic oncologic surgery may be considered ≥ 4 weeks after COVID-19 recovery in carefully selected patients. Further prospective studies are needed to assess safety in earlier postoperative intervals and among patients recovering from severe infection.
Data availability
Data are available from the corresponding author upon reasonable request.
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Acknowledgements
Thank Professor Jin Liu of the First Affiliated Hospital with Nanjing Medical University for the guidance of statistics in this study.
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No external funding was procured for this clinical trial.
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Y.Z. and Y.L. performed the formal analysis and investigation, and drafted the original manuscript. H.X. contributed to the formal analysis, investigation, methodology, and visualization. L.Y. and Y.W. were responsible for data curation and visualization. X.Z., H.L., and B.G. contributed to study conceptualization and supervision, and critically reviewed the manuscript. B.G. also acquired the funding. All authors reviewed and approved the final manuscript.
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Ethical approval for this multicenter study was obtained from the Institutional Review Boards of all three participating hospitals, and the requirement for informed consent was waived.
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Zhang, Y., Liu, Y., Xu, H. et al. Elective thoracic oncologic resections in selected patients appear safe beyond four weeks after COVID-19 infection. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39978-3
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DOI: https://doi.org/10.1038/s41598-026-39978-3
