Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection - The Lancet

4-4-2020; https://doi.org/10.1016/j.eclinm.2020.100331
By: S. Lei, et al.

Aim
Present clinical characteristics and outcomes of patients undergoing elective surgery during covid-19 incubation period. 

Keys

• 34 patients undergoing elective surgery during incubation period of covid-19 were included:
  • 100% of patients had postoperative pneumonia, 32.4% ARDS, 29.4% shock, 23.5% arrhytmia and 14.7% acute cardiac injury. 
  • 44.1% required ICU admittance
  • 46.7% of ICU patients received ventilation. 
  • 20.5% of patients died during hospital admission (age range 34 - 83 years). Median days from symptoms to death: 9. 
  • The data in this study suggest that surgery may accelerate and exacerbate disease progression of COVID-19.

Summary

• Data from 4 Chinese hospitals in endemic areas are presented. 34 Patients undergoing surgery between 1-1 and 5-2 2020 who developed covid-19 in the postoperative period were included. Patients who were visited by covid positive visitors were excluded. 
• Different surgeries were included ranging from low risk (wound debridement) to high risk (colectomy, cesarean, lobectomy)
•  34 patients, residence Wuham, median age 55 yrs [21-84 yrs]. 
• 44.1% ICU admittance due to organ failure or need for mechanical ventilation. 
• Patients admitted to ICU vs non-ICU had longer surgical times (median 200 vs 70 min) and shorter time between surgery and onset of symptoms (median 2 dys vs 5 dys)
• Symptoms at onset: fever (31 [91·2%]), fatigue (25 [73·5%]), dry cough (18 [52·9%]), dyspnea (15 [44·1%]), myalgia or arthralgia (11 [32·4%]), and expectoration (11 [32·4%]). Less common symptoms were dizziness, headache, pharyngalgia, nausea, diarrhea, and abdominal pain.
• ICU patients were older (median 55 yrs vs 47 yrs) and more comorbidities (mostly hypertension and cardiovascular disease)
• High levels of white blood cell count, neutrofils, billirubin, creatine and urea nitrogen wereindicators of severe disease.
• All the 34 patients demonstrated bilateral distribution of patchy shadows or ground glass opacity on chest CT scan. 
• 100% of patients had postoperative pneumonia, 32.4% ARDS, 29.4% shock, 23.5% arrhytmia and 14.7% acute cardiac injury. 
• 46.7% of ICU patients received ventilation. 
• 20.5% of patients died during hospital admission (age range 34 - 83 years). Median days from symptoms to death: 9. 
• The data in this study suggest that surgery may accelerate and exacerbate disease progression of COVID-19.
• Surgery may not only cause immediate impairment immune function, but also induce early systemic inflammatory response.