COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period - Annals of Surgery

Bron: 24-3-2020; https://journals.lww.com/annalsofsurgery/Documents/COVID-19%20Outbreak%20and%20Surgical%20Practice%20-%20Unexpected%20Fatality%20in%20Perioperative%20Period.pdf
By: Aminian, et al. 

Aim
Little is known about surgical practice in the initial phase of the COVID-19 pandemic. The aim of this report is to describe the clinical presentation and outcomes of elective surgical patients during the COVID-19 outbreak.

Summary

• Small case-series of 4 patients with postoperative complications after elective surgery in Iran just before the official outbreak. 
• Three patients developed postoperative fever and pulmonary complications after uneventful elective operations.
• 2 Patients died
• Correct diagnosis and management in the perioperative setting was challenging
• Next to frail and elderly patients, postoperative patients may also be a risk-population for severe covid19 due to the effects of surgical and anesthesia stress, perioperative medications, and postoperative change (e.g. occurrence of lung atelectasis) 
• Postoperative patients with fever and respiratory symptoms have a challenging differential diagnosis ( pneumonia, aspiration pneumonia, pulmonary embolism, pulmonary edema and other conditions ) but covid19 should be investigated!
• CT-thorax is supposed to have a higher sensitivity than pCR
• Elective surgery on asymptomatic patients might lead to spread or contamination of the OR