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Hegde HV, Chackochan A, Al Bahri RS, Abdullah RM, Paul M, Kandachar SS, Nair SG, Weerasinghe AS, Kulikadavunkal J, Mohnani UC. Postoperative Outcomes in Surgical Coronavirus Disease 2019 Patients: A Retrospective Cohort Study. J Perianesth Nurs 2025; 40:277-280. [PMID: 39093233 DOI: 10.1016/j.jopan.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) who require surgical procedures are likely to experience higher postoperative mortality and morbidity. Our objective was to evaluate the perioperative course of patients infected with SARS-COV-2 undergoing surgical procedures. The purpose of this study was to describe the characteristics, outcomes, and the effect of the presence of symptoms. DESIGN Retrospective cohort. METHODS We analyzed the records of patients with SARS-CoV-2 infection who underwent surgical procedures from March 2020 to March 2021. Patients with ongoing infection at the time of surgery and those who had recently recovered were included. The primary outcome measure was 30-day in-hospital mortality after surgery. Secondary outcomes were intensive care unit (ICU) admission, length of stay in ICU, postoperative length of stay, and complications. FINDINGS Data from 102 patients were analyzed. Twenty-four patients (23.5%) died postoperatively in the hospital within 30 days. Forty-four patients required ICU admission (average stay 13 days). The median postoperative length of stay was 8 days (interquartile range, 3.75 to 19.25 days). Pulmonary, thromboembolic, and surgical complications were noted in 29 (28.4%), 14 (13.7%), and 18 (17.6%), respectively. Patients aged 41 to 60 years experienced higher rates of pulmonary and thromboembolic complications. Comparison of asymptomatic versus symptomatic patients revealed significantly higher 30-day in-hospital mortality (9 [15%] vs 15 [35.7%], P = .019), ICU admission (17 [28.3%] vs 27 [64.3%], P < .001), length of stay in ICU (3 [2 to 11.5] vs 18 [7 to 27], P = .001), postoperative length of stay (6 [3 to 10.75] vs 12 [5 to 25.25], P = .016) and pulmonary complication rates (11 [18.3%] vs 18 [42.9%], P = .008) in the symptomatic patients. CONCLUSIONS Symptomatic SARS-COV-2 patients undergoing surgical procedures experience significantly higher 30-day in-hospital mortality, ICU admission, longer ICU and hospital stay, and pulmonary complications.
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Affiliation(s)
- Harihar V Hegde
- Department of Anaesthesia and Intensive Care, Royal Hospital, Muscat, Sultanate of Oman.
| | - Aswathy Chackochan
- Department of Anaesthesia and Intensive Care, Royal Hospital, Muscat, Sultanate of Oman
| | - Raiya S Al Bahri
- Department of Anaesthesia and Intensive Care, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Manisha Paul
- Department of Anaesthesia and Intensive Care, Royal Hospital, Muscat, Sultanate of Oman
| | | | | | | | | | - Umesh Chandra Mohnani
- Department of Anaesthesia and Intensive Care, Royal Hospital, Muscat, Sultanate of Oman
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Zaki DP, Zeng E, Duet ML, Stone CE, Giglio RS, Tapp MW, Llull R, Calder BW, Robinson JM. Impact of COVID-19 on Thrombotic Complications in Microsurgery: Deep Inferior Epigastric Perforator Flap Outcomes Amid Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2025; 13:e6544. [PMID: 39958714 PMCID: PMC11828035 DOI: 10.1097/gox.0000000000006544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 12/13/2024] [Indexed: 02/18/2025]
Abstract
Background Emerging research underscores the heightened risk of vasculitis and microvascular thrombosis in COVID-19 patients, alongside concerns about prothrombotic events post-severe acute respiratory syndrome coronavirus 2 vaccination. Following the pandemic's end, we sought a comprehensive analysis to elucidate its impact on microsurgical thrombosis rates, informed by empirical and anecdotal evidence. Methods An institutional review board-approved retrospective review analyzed autologous breast reconstruction cases in women from January 2019 to March 2022. Data on patient history, COVID-19 infection, vaccination status, and postoperative complications were collected. Patients were categorized as prepandemic and pandemic, and based on COVID-19 influence (infection or vaccination) for statistical evaluation. Results Among 527 patients, 216 underwent surgery prepandemic and 311 during the pandemic, revealing thrombotic event rates of 3.2% and 5.4%, respectively. Further comparative analysis showed no significant difference in thrombotic events among patients affected by COVID-19 through infection or vaccination during the pandemic. Conclusions Contrary to concerns, COVID-19 infection or vaccination status does not significantly increase thrombotic event rates in deep inferior epigastric perforator flap breast reconstructions. This study offers vital insights, affirming the safety and efficacy of microsurgical procedures amid the pandemic, thereby guiding microsurgeons in optimizing patient care in the post-COVID-19 era.
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Affiliation(s)
- Daniel P. Zaki
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Eric Zeng
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mary L. Duet
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Courtney E. Stone
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | | | - Marion W. Tapp
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Ramon Llull
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Bennett W. Calder
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - John M. Robinson
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
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Bansal S, Giribabu P, Sriganesh K, Shukla D. Perioperative outcomes in patients with symptomatic versus asymptomatic previous COVID-19 infection undergoing neurosurgical treatment (post-COVID-19 study). J Anaesthesiol Clin Pharmacol 2025; 41:98-105. [PMID: 40026747 PMCID: PMC11867355 DOI: 10.4103/joacp.joacp_313_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2025] Open
Abstract
Background and Aims The long-term effects of coronavirus disease 2019 (COVID-19) infection (long-COVID) are being increasingly recognized. The long-COVID effects are more likely in individuals who were symptomatic than asymptomatic during their previous COVID-19 infection. The data on perioperative outcomes of patients undergoing elective neurosurgery long after their recovery from COVID-19 infection is lacking. The primary objective of this study was to compare the perioperative outcomes after elective neurosurgery between patients who were symptomatic and those who were asymptomatic during their previous COVID-19 infection. The secondary objectives were to compare the earlier COVID-19 characteristics and the perioperative pulmonary profile during current surgery between these groups. Material and Methods This prospective observational study was performed in adult patients undergoing elective neurosurgery with history of previous COVID-19 infection. Data was collected regarding previous COVID-19 infection (symptoms, hospitalization, treatment, complications, etc.) and current perioperative characteristics (pulmonary profile, perioperative complications, hospital stay, mortality, etc.). Results A total of 50 patients were recruited during the study period, of which 35 (73%) patients were symptomatic during previous COVID-19 infection (two patients were excluded). The mean duration between current surgery and previous COVID-19 infection was 7 months. Patients symptomatic during earlier COVID-19 infection were females, older, and had a lower oxygen level during current surgery. There was no difference between symptomatic and asymptomatic groups in adverse perioperative outcomes such as desaturation, pulmonary or extrapulmonary complications, or non-extubation. Conclusion The perioperative outcomes of patients undergoing elective neurosurgery with previous mild to moderate symptomatic COVID-19 infection may not be different from those of patients with asymptomatic COVID-19 infection.
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Affiliation(s)
- Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Parthiban Giribabu
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kamath Sriganesh
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Amzallag E, Panchadsaram T, Girard M, Lecluyse V, Couture E, D'Aragon F, Kandelman S, Turgeon AF, Jodoin C, Beaulieu P, Richebé P, Carrier FM. Pulmonary complications and mortality among COVID-19 patients undergoing a surgery: a multicentre cohort study. BMJ Open 2024; 14:e090158. [PMID: 39578040 PMCID: PMC11590826 DOI: 10.1136/bmjopen-2024-090158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 10/30/2024] [Indexed: 11/24/2024] Open
Abstract
OBJECTIVES Our primary objective was to assess the association between symptoms at the time of surgery and postoperative pulmonary complications and mortality in patients with COVID-19. Our secondary objective was to compare postoperative outcomes between patients who had recovered from COVID-19 and asymptomatic patients and explore the effect of the time elapsed between infection and surgery in the former. Our hypotheses were that symptomatic patients had a higher risk of pulmonary complications, whereas patients who had recovered from the infection would exhibit outcomes similar to those of asymptomatic patients. BACKGROUND Managing COVID-19-positive patients requiring surgery is complex due to perceived heightened perioperative risks. However, Canadian data in this context remains scarce. DESIGN To address this gap, we conducted a multicentre observational cohort study. SETTING Across seven hospitals in the province of Québec, the Canadian province was most affected during the initial waves of the pandemic. PARTICIPANTS We included adult surgical patients with either active COVID-19 at the time of surgery or those who had recovered from the disease, from March 22, 2020 to April 30, 2021. OUTCOMES We evaluated the association between symptoms or recovery time and postoperative pulmonary complications and hospital mortality using multivariable logistic regression and Cox models. The primary outcome was a composite of any postoperative pulmonary complication (atelectasis, pneumonia, acute respiratory distress syndrome and pneumothorax). Our secondary outcome was hospital mortality, assessed from the date of surgery up to hospital discharge. RESULTS We included 105 patients with an active infection (47 were symptomatic and 58 were asymptomatic) at the time of surgery and 206 who had recovered from COVID-19 prior to surgery in seven hospitals. Among patients with an active infection, those who were symptomatic had a higher risk of pulmonary complications (OR 3.19, 95% CI 1.12 to 9.68, p=0.03) and hospital mortality (HR 3.67, 95% CI 1.19 to 11.32, p=0.02). We did not observe any significant effect of the duration of recovery prior to surgery on patients who had recovered from their infection. Their postoperative outcomes were also similar to those observed in asymptomatic patients. INTERPRETATION Symptomatic status should be considered in the decision to proceed with surgery in COVID-19-positive patients. Our results may help optimise surgical care in this patient population. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT04458337 registration date: 7 July 2020.
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Affiliation(s)
- Eva Amzallag
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Thanushka Panchadsaram
- CITADEL, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Martin Girard
- Department of Anesthesiology, CHUM, Montréal, Québec, Canada
| | - Vincent Lecluyse
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Etienne Couture
- Department of Anesthesiology and Critical Care, Quebec Heart & Lung Institute, Université Laval, Québec, Québec, Canada
| | - Frederick D'Aragon
- Anesthesiology, Université de Sherbrooke Faculté de médecine et des sciences de la santé, Sherbrooke, Québec, Canada
| | - Stanislas Kandelman
- Department of Anesthesiology, Centre Universitaire de Santé McGill, Montréal, Québec, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Québec, Canada
| | - Caroline Jodoin
- Department of Family Medicine, Université de Montréal, Montréal, Québec, Canada
| | | | - Philippe Richebé
- Anesthesiology and Pain Medicine, University of Montreal, Montréal, Québec, Canada
| | - Francois Martin Carrier
- Anesthesiology and Pain Medicine, University of Montreal, Montréal, Québec, Canada
- Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Kannan V, Sharma JVP. Assessment of Complications and Length of Hospital Stay Associated With Surgical Emergencies in Patients With Concurrent COVID-19 Infection. Cureus 2024; 16:e68965. [PMID: 39385929 PMCID: PMC11461990 DOI: 10.7759/cureus.68965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2024] [Indexed: 10/12/2024] Open
Abstract
The delivery of surgical services was profoundly affected by the COVID-19 pandemic, resulting in the postponement of elective surgeries and a shift in focus to essential emergency procedures. Our study aimed to assess the impact of concurrent COVID-19 infection on complications, hospital stay, and recovery following emergency surgery. A retrospective matched cohort study was conducted between July 2020 and February 2022 at a tertiary care hospital in India. Data from 48 patients with COVID-19 infection in the immediate preoperative period was compared with 48 matched controls not infected with the virus. The data collected included patient demographics, surgical procedures, duration of hospital stay, and postoperative complications. Patients with concurrent COVID-19 infection had notably longer mean hospital stays (13.44 days) than the controls (6.63 days) (P = 0.002). An elevated proportion of COVID-19-positive patients experienced discharge delays (36 out of 48, 75%), compared to just six of the 48 non-COVID-19 patients (12.5%) (P ≤ 0.001). Postoperative findings in the COVID-positive cohort revealed elevated rates of pulmonary complications (5/48, 10.4%), higher rates of postoperative ICU admissions (8/48, 16.7%), and persistently elevated D-dimer levels extending beyond postoperative day seven (18/48, 37.5%). This suggests that emergency surgery in patients with COVID-19 is linked to significantly lengthier hospital stays, increased discharge delays, and a greater prevalence of adverse events in the postoperative period when compared to controls. These findings underscore the need for enhanced perioperative strategies and preparedness for potential future pandemics.
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Affiliation(s)
- Vaishnavi Kannan
- General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
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Leeds IL, Park LS, Akgun K, Weintrob A, Justice AC, King JT. Postoperative Outcomes Associated with the Timing of Surgery After SARS-CoV-2 Infection. Ann Surg 2024; 280:241-247. [PMID: 38323413 PMCID: PMC11236522 DOI: 10.1097/sla.0000000000006227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Examine the association between prior SARS-CoV-2 infection, interval from infection to surgery, and adverse surgical outcomes. SUMMARY BACKGROUND DATA Earlier series have reported worse outcomes for surgery after COVID-19 illness, and these findings have led to routinely deferring surgery seven weeks after infection. METHODS We created a retrospective cohort of patients from the US Veterans Health Administration facilities nationwide, April 2020 to September 2022, undergoing surgical procedures. Primary outcomes were 90-day all-cause mortality and 30-day complications. Within surgical procedure groupings, SARS-CoV-2 infected and uninfected patients were matched in a 1:4 ratio. We categorized patients by 2-week intervals from SARS-CoV-2 positive test to surgery. Hierarchical multilevel multivariable logistic regression models were used to estimate the association between infection to surgery interval versus no infection and primary end points. RESULTS We identified 82,815 veterans undergoing eligible operations (33% general, 27% orthopedic, 13% urologic, 9% vascular), of whom 16,563 (20%) had laboratory-confirmed SARS-CoV-2 infection before surgery. The multivariable models demonstrated an association between prior SARS-CoV-2 infection and increased 90-day mortality (odds ratio (OR) 1.42, 95% CI: 1.08, 1.86) and complications (OR 1.32, 95% CI: 1.11, 1.57) only for patients having surgery within 14 days of infection. ASA-stratified multivariable models showed that the associations between increased 90-day mortality (OR 1.40, 95% CI: 1.12, 1.75) and complications (OR 1.73, 95% CI: 1.34, 2.24) for patients having surgery within 14 days of infection were confined to those with ASA 4-5. CONCLUSIONS In a contemporary surgical cohort, patients with prior SARS-CoV-2 infection only had increased postoperative mortality or complications when they had surgery within 14 days after the positive test. These findings support revising timing recommendations between surgery and prior SARS-CoV-2 infection.
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Affiliation(s)
- Ira L Leeds
- Department of Surgery, Yale University School of Medicine, New Haven, CT
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Lesley S Park
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Kathleen Akgun
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Amy Weintrob
- Veterans Affairs Washington DC Healthcare System, Washington, DC
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Department of Medicine, Yale University School of Medicine, New Haven, CT
- Department of Public Policy, School of Public Health, Yale University School of Medicine, New Haven, CT
| | - Joseph T King
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
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Hazzi C, Villemure-Poliquin N, Nadeau S, Champagne PO. SARS-CoV-2 Infection, A Risk Factor for Pituitary Apoplexy? A Case Series and Literature Review. EAR, NOSE & THROAT JOURNAL 2024; 103:153S-161S. [PMID: 37291861 PMCID: PMC10261951 DOI: 10.1177/01455613231179714] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction: Pituitary apoplexy (PA) is a rare phenomenon, characterized by a hemorrhagic or ischemic event of the pituitary gland, most often in association with a pituitary lesion. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the strain of virus responsible for the internationally recognized global pandemic COVID-19. Multiple clinical manifestations associated with this virus have been described, ranging from asymptomatic, mild flu symptoms to acute respiratory distress syndrome, end-organ failure leading to death. Cases of patients with concomitant COVID-19 infections and PA are being further recognized in the literature, but the causal association between the 2 entities remains speculative. Objectives: The objectives of this case series are 3-fold: to describe additional cases of patients with concomitant COVID-19 infection and PA (1), to review the current evidence regarding this potential complication associated with a COVID-19 infection (2), and to discuss physiopathological hypotheses, treatments, and prognoses of this newly recognized association (3). Method: We conducted an electronic chart review of patients treated for PA with concomitant COVID-19 infection from March 2020 to December 2021. A literature review was performed using MEDLINE, Web of Science, and Embase databases to identify other cases of COVID-19-associated PA. Results: From March 2020 to December 2021, 3 patients presented to our center with PA following a symptomatic COVID-19 infection. Two of these patients developed PA symptoms days following the viral infection, whereas the third patient developed PA after a 2-month period. The 2 first patients were managed surgically because of persistent visual symptoms. Results from our literature review yielded 12 other cases of COVID-19-associated PAs. Conclusions: The association between COVID-19 infection and PA has been increasingly reported in the literature. With the addition of the 3 cases described in our article, a total of 15 cases have been published. Many contributing mechanisms may lead to PA following COVID-19 infection. Coagulopathy is probable major contributing cause responsible for hemorrhage or infarction of the pituitary gland. Our case series provides further arguments that PA may be a direct manifestation of a COVID-19 infection.
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Affiliation(s)
- Christina Hazzi
- Department of Ophthalmology and Otolaryngology—Head and Neck Surgery, CHU de Québec, Quebec, QC, Canada
| | - Noémie Villemure-Poliquin
- Department of Ophthalmology and Otolaryngology—Head and Neck Surgery, CHU de Québec, Quebec, QC, Canada
| | - Sylvie Nadeau
- Department of Ophthalmology and Otolaryngology—Head and Neck Surgery, CHU de Québec, Quebec, QC, Canada
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Oh AR, Kang ES, Park J, Lee SM, Jeong M, Lee JH. Does coronavirus disease 2019 history alone increase the risk of postoperative pulmonary complications after surgery? Prospective observational study using serology assessment. PLoS One 2024; 19:e0300782. [PMID: 38771760 PMCID: PMC11108156 DOI: 10.1371/journal.pone.0300782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/05/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Concern exists about the increasing risk of postoperative pulmonary complications in patients with a history of coronavirus disease 2019 (COVID-19). OBJECTIVE We conducted a prospective observational study that compared the incidence of postoperative pulmonary complications in patients with and without a history of COVID-19. METHODS From August 2022 to November 2022, 244 adult patients undergoing major non-cardiac surgery were enrolled and allocated either to history or no history of COVID-19 groups. For patients without a history of confirming COVID-19 diagnosis, we tested immunoglobulin G to nucleocapsid antigen of SARS-CoV-2 for serology assessment to identify undetected infection. We compared the incidence of postoperative pulmonary complications, defined as a composite of atelectasis, pleural effusion, pulmonary edema, pneumonia, aspiration pneumonitis, and the need for additional oxygen therapy according to a COVID-19 history. RESULTS After excluding 44 patients without a COVID-19 history who were detected as seropositive, 200 patients were finally enrolled in this study, 100 in each group. All subjects with a COVID-19 history experienced no or mild symptoms during infection. The risk of postoperative pulmonary complications was not significantly different between the groups according to the history of COVID-19 (24.0% vs. 26.0%; odds ratio, 0.99; 95% confidence interval, 0.71-1.37; P-value, 0.92). The incidence of postoperative pulmonary complications was also similar (27.3%) in excluded patients owing to being seropositive. CONCLUSION Our study showed patients with a history of no or mild symptomatic COVID-19 did not show an increased risk of PPCs compared to those without a COVID-19 history. Additional precautions may not be needed to prevent PPCs in those patients.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mijeong Jeong
- Research Institute for Future Medicine, R&D Management & Supporting Team, Republic of Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wenzel AN, Marrache M, Schmerler J, Kinney J, Khanuja HS, Hegde V. Impact of Postoperative COVID-19 Infection Status on Outcomes in Elective Primary Total Joint Arthroplasty. J Arthroplasty 2024; 39:871-877. [PMID: 37852450 DOI: 10.1016/j.arth.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Although Coronavirus disease 2019 (COVID-19) infection causes major morbidity and mortality, it is unclear what the impact of postoperative COVID-19 infection is on 30-day outcomes after total joint arthroplasty (TJA). METHODS There were 2,340 patients who underwent TJA in 2021, identified using the National Surgical Quality Improvement Program database, with 925 total hip arthroplasty (THA) patients (39.5%) and 1,415 total knee arthroplasty (TKA) patients (60.5%), overall. Propensity score matching was implemented using patient demographics and preoperative medical conditions to compare outcomes for postoperative COVID-19-positive and COVID-19-negative patients who underwent TKA or THA. RESULTS Postoperative COVID-19-positive THA patients were found to have a significantly increased risk of pneumonia (odds ratio [OR] 42.57), sepsis (OR 12.77), readmission (OR 12.06), non-home discharge (OR 3.78), and longer length of stay (hazard ratio 1.62). Postoperative COVID-19-positive TKA patients had an increased risk of 30-day mortality (OR 14.17), superficial infection (OR 3.17), pneumonia (OR 34.68), unplanned intubation (OR 18.31), ventilator use for more than 48 hours (OR 18.31), pulmonary embolism (OR 11.98), urinary tract infection (OR 5.16), myocardial infarction (OR 16.02), deep vein thrombosis (OR 4.69), non-home discharge (OR 1.79), reoperation (OR 3.17), readmission (OR 9.61), and longer length of stay (hazard ratio 1.49). CONCLUSIONS Patients who contracted COVID-19 within 30 days after TJA were at increased risk of mortalities, medical complications, readmissions, reoperations, and non-home discharges. It is important for orthopedic surgeons to understand these adverse outcomes to better counsel patients and mitigate these risks, particularly in higher risk populations.
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Affiliation(s)
- Alyssa N Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason Kinney
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vishal Hegde
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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10
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Karna ST, Ahmad Z, Thaware P, Trivedi S, Gouroumourty R, Singh P, Waindeskar V, Sharma JP, Kaushal A, Saigal S. Postoperative Outcomes After Emergency Surgery in COVID-19 Patients: An Ambispective Matched Cohort Study. Cureus 2024; 16:e55845. [PMID: 38590490 PMCID: PMC11001162 DOI: 10.7759/cureus.55845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose There is limited data from the Indian subcontinent regarding the surgical outcomes of coronavirus disease (COVID-19) patients. In this observational study, we aimed to evaluate the postoperative outcomes after emergency surgery in COVID-19 patients compared to concurrent age and gender-matched controls. We also sought to analyze the possible predictors of postoperative mortality in COVID-19 patients. Methods This matched cohort study was conducted in a tertiary care teaching hospital in central India, between 1st July 2021 and 30th June 2022. COVID-19-positive patients undergoing emergency surgery under anesthesia were recruited as cases. Age and gender-matched COVID-19-negative patients undergoing a similar nature of surgery in the same period served as concurrent controls. The cases and controls were compared for the 30-day mortality and perioperative complications. Results The COVID-19-positive surgical cohort had a 12.3 times greater 30-day postoperative overall mortality risk as compared to a matched cohort of patients with a negative COVID-19 test. A positive COVID-19 status was associated with more postoperative complications of acute respiratory distress syndrome (ARDS), sepsis, shock, and persistent hyperglycemia. On analysis of predictors of mortality, the presence of preoperative dyspnea, ARDS, American Society of Anesthesiologists Physical Status (ASA-PS) Class IIIE/IVE, increase in sequential organ failure assessment (SOFA) score, Quick SOFA>1, higher creatinine, bilirubin, and lower albumin were observed to be associated with increased mortality. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing emergency surgery is significantly associated with higher postoperative complications and increased 30-day postoperative mortality.
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Affiliation(s)
- Sunaina T Karna
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Zainab Ahmad
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Thaware
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Trivedi
- Anesthesiology, Chirayu Medical College and Hospital, Bhopal, IND
| | - Revadi Gouroumourty
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Singh
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Vaishali Waindeskar
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jai Prakash Sharma
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ashutosh Kaushal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Saigal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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11
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Badrudin D, Lesurtel M, Shrikhande S, Gallagher T, Heinrich S, Warner S, Chaudhari V, Koo D, Anantha S, Molina V, Calvo MP, Allard MA, Doussot A, Kourdouli A, Efanov M, Oddi R, Barros-Schelotto P, Erkan M, Lidsky M, Garcia F, Gelli M, Kaldarov A, Granero P, Meurisse N, Adam R. International Hepato-Pancreato-Billiary Association (IHPBA) registry study on COVID-19 infections in HPB surgery patients. HPB (Oxford) 2024; 26:102-108. [PMID: 38038484 DOI: 10.1016/j.hpb.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND In response to the pandemic, the International Hepato-Pancreato-Biliary Association (IHPBA) developed the IHPBA-COVID Registry to capture data on HPB surgery outcomes in COVID-positive patients prior to mass vaccination programs. The aim was to provide a tool to help members gain a better understanding of the impact of COVID-19 on patient outcomes following HPB surgery worldwide. METHODS An online registry updated in real time was disseminated to all IHPBA, E-AHPBA, A-HPBA and A-PHPBA members to assess the effects of the pandemic on the outcomes of HPB procedures, perioperative COVID-19 management and other aspects of surgical care. RESULTS One hundred twenty-five patients from 35 centres in 18 countries were included. Seventy-three (58%) patients were diagnosed with COVID-19 preoperatively. Operative mortality after pancreaticoduodenectomy and major hepatectomy was 28% and 15%, respectively, and 2.5% after cholecystectomy. Postoperative complication rates of pancreatic procedures, hepatic interventions and biliary interventions were respectively 80%, 50% and 37%. Respiratory complication rates were 37%, 31% and 10%, respectively. CONCLUSION This study reveals a high risk of mortality and complication after HPB surgeries in patient infected with COVID-19. The more extensive the procedure, the higher the risk. Nonetheless, an increased risk was observed across all types of interventions, suggesting that elective HPB surgery should be avoided in COVID positive patients, delaying it at distance from the viral infection.
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Affiliation(s)
- David Badrudin
- HPB & Transplant Surgery, Assistant Professor of Surgery, Department of Surgery, Université de Montréal, Montreal, Canada
| | - Mickaël Lesurtel
- Head of HPB Surgery & Liver Transplantation, Beaujon Hospital - University of Paris Cité, Paris, France
| | - Shailesh Shrikhande
- Deputy Director and Head of Cancer Surgery, Tata Memorial Hospital, Mumbai, India
| | | | | | | | - Vikram Chaudhari
- Gastrointestinal and HPB Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Donna Koo
- Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Sandeep Anantha
- Director of Surgical Oncology- LIJ Forest Hills Hospital, New York, USA
| | - Víctor Molina
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Marc-Antoine Allard
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, AP-HP, Villejuif, France
| | | | | | | | - Ricardo Oddi
- Center for Clinical Medical Education and Research (CEMIC), Buenos Aires, Argentina
| | | | - Mert Erkan
- Koç University School of Medicine, Istanbul, Turkey
| | | | | | | | | | - Pablo Granero
- Central University Hospital of Asturias, Oviedo, Spain
| | | | - René Adam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, AP-HP, Villejuif, France.
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12
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Das G, Talukdar A, Bhutia K, Talukdar A. Outcomes of Patients Undergoing Major Surgery for Cancer with COVID-19 in the Postoperative Period. Indian J Surg Oncol 2023; 14:876-880. [PMID: 38187838 PMCID: PMC10766581 DOI: 10.1007/s13193-023-01797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/04/2023] [Indexed: 01/09/2024] Open
Abstract
The aim of our study was to report about the clinical outcomes of patients who underwent major surgery for cancer and developed COVID-19 in the postoperative period. A retrospective and observational study was done in the Surgical Oncology Division of a tertiary care cancer hospital in North-East India. The study period was from 1st April 2020 to 31st December 2021. Patients with a confirmed diagnosis of cancer who underwent a major surgery and developed COVID-19 in the postoperative period, within the same hospital stay were included in the study. Data was obtained from a prospectively maintained database and case records. Descriptive statistics were used to state the results in median values, range and percentages. A total of 22 patients developed COVID-19 in the postoperative period during the study period out of a total of 1402 patients operated during that time period (1.57%). The have been followed up for a median period of 16 months (range 2 to 18 months). The median age at presentation was 50 years (range 25 to 74 years). The incidence of co-morbidities was 27.3%. The median duration of ICU stay was 3 days (range 0 to 9 days) and median duration of hospital stay was 22 days (range 9 to 55 days).. The postoperative mortality rate was 18.2%. COVID-19 in the postoperative period in patients undergoing major abdominal and thoracic surgeries for cancer caused high postoperative mortality and prolonged hospital stay.
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Affiliation(s)
- Gaurav Das
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 30, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Amrita Talukdar
- Department of Microbiology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Karma Bhutia
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 30, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Abhijit Talukdar
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 28, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
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13
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Momeeh MY, Alrumayh MM, Ahmed K, Alharbi FL. Postoperative Complications in Patients With the Preoperative COVID-19 Infection at King Fahad Specialist Hospital: A Retrospective Cohort Study. Cureus 2023; 15:e50037. [PMID: 38186544 PMCID: PMC10768319 DOI: 10.7759/cureus.50037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) is an infectious disease caused by a new coronavirus strain. Indeed, the timing of COVID-19 infection before surgery plays an important role in the surgery outcomes and complications. OBJECTIVE In this study, we aimed to assess the prevalence and predictors of postoperative complications for patients who underwent surgery with previous COVID-19 infection. METHODOLOGY This was a retrospective hospital-based study which was conducted on 75 patients who had been infected with COVID-19 and underwent surgery. RESULTS We included 75 patients. The time between COVID-19 infection and the surgery was from one to six months in 52% of patients, 24% of patients were more than six months, and 24% of patients were less than one month. In this study, most of the patients had no complications (77.3%) while 22.7% of patients had complications that were mainly respiratory (n= 13). The overall mortality in our study was 5.3%. There was a significant association between comorbidity and postoperative complications, and the status of COVID-19 preoperative and postoperative complications (p < 0.01) but not patients' age as well as the type of anesthesia and postoperative complication (p > 0.05). CONCLUSION Respiratory complications were the most common postoperative complications in patients who had surgery after COVID-19 infection. Comorbidity and COVID-19 status were significantly associated with higher postoperative complications. Mortality was relatively small. We recommend extreme care to patients with COVID-19 infection prior to surgery to decrease the COVID-19 hazards that develop post-surgery.
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Affiliation(s)
| | | | - Khiloud Ahmed
- Anesthesia, Maternity and Children Hospital, Buraidah, SAU
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14
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Argandykov D, Dorken-Gallastegi A, El Moheb M, Gebran A, Proaño-Zamudio JA, Bokenkamp M, Renne AM, Nepogodiev D, Bhangu A, Kaafarani HM. Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis. J Trauma Acute Care Surg 2023; 94:513-524. [PMID: 36949053 PMCID: PMC10044588 DOI: 10.1097/ta.0000000000003859] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients undergoing surgery with perioperative COVID-19 are suggested to have worse outcomes, but whether this is COVID-related or due to selection bias remains unclear. We aimed to compare the postoperative outcomes of patients with and without perioperative COVID-19. METHODS Patients with perioperative COVID-19 diagnosed within 7 days before or 30 days after surgery between February and July 2020 from 68 US hospitals in COVIDSurg, an international multicenter database, were 1:1 propensity score matched to patients without COVID-19 undergoing similar procedures in the 2012 American College of Surgeons National Surgical Quality Improvement Program database. The matching criteria included demographics (e.g., age, sex), comorbidities (e.g., diabetes, chronic obstructive pulmonary disease, chronic kidney disease), and operation characteristics (e.g., type, urgency, complexity). The primary outcome was 30-day hospital mortality. Secondary outcomes included hospital length of stay and 13 postoperative complications (e.g., pneumonia, renal failure, surgical site infection). RESULTS A total of 97,936 patients were included, 1,054 with and 96,882 without COVID-19. Prematching, COVID-19 patients more often underwent emergency surgery (76.1% vs. 10.3%, p < 0.001). A total of 843 COVID-19 and 843 non-COVID-19 patients were successfully matched based on demographics, comorbidities, and operative characteristics. Postmatching, COVID-19 patients had a higher mortality (12.0% vs. 8.1%, p = 0.007), longer length of stay (6 [2-15] vs. 5 [1-12] days), and higher rates of acute renal failure (19.3% vs. 3.0%, p < 0.001), sepsis (13.5% vs. 9.0%, p = 0.003), and septic shock (11.8% vs. 6.0%, p < 0.001). They also had higher rates of thromboembolic complications such as deep vein thrombosis (4.4% vs. 1.5%, p < 0.001) and pulmonary embolism (2.5% vs. 0.4%, p < 0.001) but lower rates of bleeding (11.6% vs. 26.1%, p < 0.001). CONCLUSION Patients undergoing surgery with perioperative COVID-19 have higher rates of 30-day mortality and postoperative complications, especially thromboembolic, compared with similar patients without COVID-19 undergoing similar surgeries. Such information is crucial for the complex surgical decision making and counseling of these patients. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
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15
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Cata JP, Hu J, Feng L, Chung C, Woodman SE, Meyer LA. Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study. J Pers Med 2023; 13:274. [PMID: 36836508 PMCID: PMC9959979 DOI: 10.3390/jpm13020274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with a history of COVID-19 could have an exaggerated risk of developing postoperative delirium after undergoing major elective oncologic surgery. METHODS We conducted a retrospective study to determine the association between COVID-19 status and antipsychotic drugs during postsurgical hospitalization as a surrogate of delirium. Secondary outcomes included 30 days of postoperative complications, length of stay, and mortality. Patients were grouped into pre-pandemic non-COVID-19 and COVID-19-positive groups. A 1:2 propensity score matching was used to minimize bias. A multivariable logistic regression model estimated the effects of important covariates on the use of postoperative psychotic medication. RESULTS A total of 6003 patients were included in the study. Pre- and post-propensity score matching demonstrated that a history of preoperative COVID-19 did not increase the risk of antipsychotic medications postoperatively. However, respiratory and overall 30-day complications were higher in COVID-19 individuals than in pre-pandemic non-COVID-19 patients. The multivariate analysis showed that the odds of using postoperative antipsychotic medication use for the patients who had COVID-19 compared to those who did not have the infection were not significantly different. CONCLUSION A preoperative diagnosis of COVID-19 did not increase the risk of postoperative antipsychotic medication use or neurological complications. More studies are needed to reproduce our results due to the increased concern of neurological events post-COVID-19 infection.
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Affiliation(s)
- Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX 77030, USA
| | - Jian Hu
- Department of Cancer Biology, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
- Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Scott E. Woodman
- Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
- Department of Genomic Medicine, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Larissa A. Meyer
- Department of Gynecology Oncology and Reproductive Medicine, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
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16
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Bîrlă R, Panaitescu E, Ceban C, Radu AV, Hoară P, Constantin A, Păduraru DN, Bordianu A, Cristian DA, Constantinoiu S. The Influence of the COVID-19 Pandemic on Mortality of Patients Hospitalized in Surgical Services in Romania: A Cross-Sectional Study of a National Survey. SUSTAINABILITY 2022; 15:237. [DOI: 10.3390/su15010237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Surgical practice worldwide has changed rapidly in response to the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to analyze the impact of the COVID-19 pandemic on mortality, in hospitalized patients, in Romanian surgical services. We have developed our research on a national survey of the consecutive records of hospitalizations, surgical interventions and deaths performed in Romania between March and August 2020. Results show that 47 surgical departments responded to the request. The admissions in the period March–August 2020 represented 52% of that from the similar period of 2019. In the studied period, the share of surgical interventions in patients admitted to non-COVID-19 centres was 98.7%, respectively 78.2% in COVID-19 support hospitals (p < 0.05), and emergency interventions of 43.4% in non-COVID-19 hospitals, respectively 84.8% in COVID-19 support hospitals (p < 0.05). Overall mortality in this period was 5.82%, compared to 3.28% in a similar period in 2019, (p < 0.05). Postoperative mortality in COVID-19-positive patients was 19%. In conclusion, in the hospitals in Romania included in the survey, the overall mortality in the studied period was higher than in a similar period in 2019. In patients with COVID-19 positive, the recorded postoperative mortality was higher than overall mortality.
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Affiliation(s)
- Rodica Bîrlă
- General Surgery Department, Clinic of General and Esophageal Surgery, “Sf. Maria” Clinical Hospital, Faculty of Medicine, “CarolDavila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Eugenia Panaitescu
- Medical Informatics and Biostatistics Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cornelia Ceban
- Oftalmology Department, “NicolaeTestemițanu” State University of Medicine and Pharmacy of the Republic of Moldova, 2004 Chișinău, Moldova
| | - Andra-Victoria Radu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Petre Hoară
- General Surgery Department, Clinic of General and Esophageal Surgery, “Sf. Maria” Clinical Hospital, Faculty of Medicine, “CarolDavila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adrian Constantin
- General Surgery Department, Clinic of General and Esophageal Surgery, “Sf. Maria” Clinical Hospital, Faculty of Medicine, “CarolDavila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dan Nicolae Păduraru
- University Emergency Hospital of Bucharest, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Bordianu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniel Alin Cristian
- Clinical Hospital Colțea, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Silviu Constantinoiu
- General Surgery Department, Clinic of General and Esophageal Surgery, “Sf. Maria” Clinical Hospital, Faculty of Medicine, “CarolDavila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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17
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Verma S, Garg P, Gera M, Agarwal S, Verma A. Complications and Outcomes of Surgical Patients Operated During COVID 19: a Single Centre Study. Indian J Surg 2022; 84:1367-1368. [PMID: 35125750 PMCID: PMC8805135 DOI: 10.1007/s12262-022-03308-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/26/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Surender Verma
- grid.420149.a0000 0004 1768 1981Department of General Surgery, PGIMS, 117- A, Sector 14, Rohtak, India
| | - Pradeep Garg
- grid.420149.a0000 0004 1768 1981Department of General Surgery, PGIMS, 117- A, Sector 14, Rohtak, India
| | - Mridul Gera
- grid.420149.a0000 0004 1768 1981Department of General Surgery, PGIMS, 117- A, Sector 14, Rohtak, India
| | - Shivika Agarwal
- grid.420149.a0000 0004 1768 1981Department of General Surgery, PGIMS, 117- A, Sector 14, Rohtak, India
| | - Anjali Verma
- grid.420149.a0000 0004 1768 1981Department of Pediatrics, PGIMS, Rohtak, India
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18
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Nishie N, Ohashi M, Makuuchi R, Hayami M, Ida S, Kumagai K, Nunobe S, Sano T. Successful open radical gastrectomy for locally advanced or metastatic gastric cancer patients who suffered from coronavirus disease 2019 during preoperative chemotherapy: a report of three cases. Surg Case Rep 2022; 8:124. [PMID: 35749018 PMCID: PMC9232676 DOI: 10.1186/s40792-022-01465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background According to previous reports, in patients with preoperative coronavirus disease 2019 (COVID-19) infection, mortality is increased if they undergo surgery within 6 weeks of diagnosis. However, the optimal timing and preoperative examination for gastrectomy with a previous COVID-19 infection are still controversial. We experienced three cases in which patients successfully underwent open radical gastrectomy following preoperative chemotherapy even though they developed COVID-19 infection during the chemotherapy. Case presentation Case 1: A 58-year-old man with locally advanced gastric cancer caught COVID-19 during preoperative chemotherapy comprising 5-fluorouracil, calcium folate, oxaliplatin, and docetaxel. Although the patient had specific lung shadows indicating COVID-19 infection and deep venous thrombosis in the lower extremities, he underwent distal gastrectomy 10 weeks after the COVID-19 diagnosis. He had a good postoperative course. Case 2: A 56-year-old man with gastric cancer and lymph node and peritoneal metastasis caught COVID-19 during palliative chemotherapy comprising S-1, oxaliplatin, and trastuzumab. He underwent total gastrectomy as conversion surgery 8 weeks after COVID-19 infection. His postoperative course was uneventful. Case 3: A 55-year-old man with gastric cancer and paraaortic lymph node and liver metastases caught COVID-19 during S-1 and oxaliplatin treatment as neoadjuvant chemotherapy. He underwent distal gastrectomy, paraaortic lymph node sampling, and partial hepatectomy 8 weeks after COVID-19 infection although he had residual lung shadows and deep venous thrombosis in the lower extremities. He had an uneventful postoperative course. Conclusions Computed tomography for preoperative evaluation was performed for all three patients and revealed that lung shadows remained post-COVID-19 infection. Despite this finding, the patients had good operative courses and were discharged as planned. Surgery after 7 weeks from the diagnosis of COVID-19 infection can be performed safely even when patients are post-chemotherapy and have residual lung findings and deep venous thrombosis. This report may contribute to the development of a consensus on performing safe gastrectomy for advanced gastric cancer in patients previously infected with COVID-19.
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19
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Prevalence of surgery cancelation and challenges in restarting elective surgery in the pandemic: A cross-sectional study. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 28:100271. [PMID: 35765516 PMCID: PMC9221740 DOI: 10.1016/j.pcorm.2022.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022]
Abstract
Objectives The COVID-19 pandemic caused primary disruption of health services, especially to elective surgery. As the pandemic goes in waves of high and low infection rates in a country, restarting elective surgery must be dynamic while balancing patients’ needs, staff safety and the hospital capacity. We aim to report the prevalence of elective surgery and minimally invasive procedures cancelation due to positive Covid-19 screening and describe steps in restarting elective cases after the third wave of Covid-19 infection. Methods This study was a descriptive cross-sectional study in Indonesia's tertiary referral and teaching hospital from January to September 2021. Subjects were patients scheduled for elective surgery or minimally invasive procedures from our outpatient clinic. Subjects were screened for SARS-CoV-2 using real-time polymerase chain reaction (rRT-PCR) 24-48 hours before scheduled surgery or intervention. Data was taken from the hospital information system and the central operating theatre online surgical list. Statistical analysis is presented in percentage. Results There were 5286 subjects identified for the study, and 3088 were included with an available PCR result from the outpatient department. The average elective cancelation rate was 7.4%, and the highest cancelation was on August 2021, with 14.7%. All subjects with positive results were asymptomatic, with more than 90% cycle time rRT-PCR above 30. Conclusion Elective surgery cancelation can reflect a trend in community infection, and monitoring its values is crucial for saving elective surgery plans during a pandemic.
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20
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Taghioff SM, Slavin BR, Narasimman M, Samaha G, Samaha M, Holton T, Singh D. The influence of SARS-CoV-2 vaccination on post-operative outcomes in microsurgery patients. Microsurgery 2022; 42:685-695. [PMID: 35838137 PMCID: PMC9349889 DOI: 10.1002/micr.30940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
Abstract
Background The healthcare industry's efforts to immunize the global community against severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) have been unprecedented. Given the fast‐tracking of the novel vaccine, its short‐ and long‐term medical implications remain largely to‐be‐determined in most patient populations. This study aims to analyze 90‐day post‐operative outcomes in microsurgical patients, who have received or not received SARS‐CoV‐2‐vaccination, using a continuously updated federated electronic medical record network (TriNetX Inc, Cambridge, MA). Methods After screening 70 million de‐identified records, 16,799 microsurgery patients aged 18–99 meeting medical coding criteria were allocated into two cohorts. Cohort One received SARS‐CoV‐2‐vaccination prior to undergoing microsurgery whereas Cohort Two did not. Two equally sized cohorts, totaling 818 patients were created after propensity score matching for characteristics including: age, race, ethnicity, smoking, hypertension, heart disease, diabetes, obesity, chronic obstructive pulmonary disease, and history of SARS‐CoV‐2 exposure. Postoperative outcomes within 30‐, 60‐, and 90‐days of microsurgery were analyzed. Results Patients who were SARS‐CoV‐2‐immunized experienced significantly lower (p < .01) surgical site infections (Absolute Risk Reduction (ARR)[95%CI]) = (3.79%–5.36% [0.84–8.54]) ICU admission (9.47%–9.82%[5.45–13.88]), generalized infections (7.68%–9.92%[3.15–14.64]), and hospitalizations (28.48%–32.57%[20.99–40.13]) within 30‐, 60‐, and 90‐days of microsurgery. Additionally, SARS‐CoV‐2‐vaccinated patients also experienced significantly less flap failure (2.49%[0.97–4.02]) and death (2.46%[0.96–3.97]) within 30‐ and 60‐days post‐operatively. Conclusion Our analysis examines the potential protective effect of SARS‐CoV‐2‐vaccination in microsurgical patients. Limitations include the retrospective nature of this analysis and the inherent reliance on medical coding. Future prospective studies are warranted to better understand if in fact pre‐operative SARS‐CoV‐2‐vaccination has the potential to protect against post‐operative microsurgery outcomes.
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Affiliation(s)
- Susan M Taghioff
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Anne Arundel Medical Center Luminis Health, Annapolis, Maryland, USA
| | - Benjamin R Slavin
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Manish Narasimman
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Georges Samaha
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mario Samaha
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tripp Holton
- Anne Arundel Medical Center Luminis Health, Annapolis, Maryland, USA
| | - Devinder Singh
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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21
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Increased Risk of Postoperative Mortality Associated With Prior COVID-19 Infection. Am J Prev Med 2022; 63:S75-S82. [PMID: 35725144 PMCID: PMC9212625 DOI: 10.1016/j.amepre.2022.01.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The impact of COVID-19 infection on surgical patients is largely described by small-cohort studies. This study characterized the risk factors for postoperative mortality among patients with preoperative COVID-19 infection. METHODS Data were abstracted from the electronic medical record for patients who tested positive for COVID-19 before surgery, excluding procedures related to extracorporeal membrane oxygenation (case, March 2020-April 2021). Mortality was compared with that for patients from the American College of Surgeons National Surgical Quality Improvement Program database (control, January 2018‒February 2020) with chi-square, t test, and multivariable regression. RESULTS There were 5,209 patients in the control cohort. Among 1,072 patients with positive COVID-19 testing before surgery, 589 had surgeries with specialties tracked by the American College of Surgeons National Surgical Quality Improvement Program (General Surgery, Gynecology, Neurosurgery, Orthopedics, Thoracic, Vascular). Patients with previous COVID-19 infection were younger (age 48 vs 59 years, p<0.001), were more likely to be Black (42% vs 28%, p<0.001), and underwent fewer elective surgeries (55% vs 83%, p<0.001). Postoperative mortality was greater among the case cohort (4.4% vs 1%, p<0.001). On multivariable logistic regression, postoperative mortality increased with age (OR=1.02), emergent surgeries (OR=2.6), and previous COVID-19 infection (OR=3.8). Among patients with previous COVID-19 infection, postoperative mortality was associated with male sex (OR=2.7), higher American Society of Anesthesiologists Physical Status Classification Score (OR=4.8), and smoking history (OR=3.7). CONCLUSIONS Although data abstraction was limited by the electronic medical record, postoperative mortality is nearly 6 times higher for patients infected with COVID-19 within 2 weeks before surgery when adjusting for patient- and procedure-level factors. Among those with previous COVID-19 infection, postoperative mortality is associated with male sex, American Society of Anesthesiologists Physical Status Classification Score, and smoking history.
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22
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Agrawal D, Saigal S. Utilization of SARS-COV-2 positive donors and recipients for liver transplantation in the pandemic era - An evidence-based review. JOURNAL OF LIVER TRANSPLANTATION 2022; 7:100081. [PMID: 38620745 PMCID: PMC8915505 DOI: 10.1016/j.liver.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 12/24/2022] Open
Abstract
The current SARS-COV-2 pandemic led to a drastic drop in liver donation and transplantation in DDLT and LDLT settings. Living donations have decreased more than deceased organ donation due to the need to protect the interest of donors. In the SARS-COV-2 pandemic, major professional societies worldwide recommended against the use of organs from donors with acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The basis for these recommendations are; SARS-CoV-2 could be transmitted to the recipient through organ transplantation and can result in severe manifestations; only limited effective targeted therapies are available, risk of transmission to the healthcare professionals, logistical limitations, and ethical concerns. In addition, end-stage liver disease patients on the waiting list represent vulnerable populations and are at higher risk for severe COVID-19 infection. Therefore, deferring life-saving transplants from COVID-positive donors during a pandemic may lead to more collateral damage by causing disease progression, increased death, and dropout from the waitlist. As this SARS-COV-2 pandemic is likely to stay with us for some time, we have to learn to co-exist with it. We believe that utilizing organs from mild/ asymptomatic COVID19 positive donors may expand the organ donor pool and mitigate disruptions in transplantation services during this pandemic.
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Affiliation(s)
- Dhiraj Agrawal
- Department of Gastroenterology and hepatology, PACE Hospitals, HITEC city, Hyderabad 500081, India
| | - Sanjiv Saigal
- Hepatology and Liver Transplant, Center for Liver & Biliary Sciences, Center of Gastroenterology, Hepatology & Endoscopy, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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James A, De Jong A, Jeanmougin T, Blanie A, Figueiredo S, Goffin P, Le Guen M, Kantor E, Cipriani F, Campion S, Raux M, Jaber S, Futier E, Constantin JM. Characteristics and outcomes of patients undergoing anesthesia while SARS-CoV-2 infected or suspected: a multicenter register of consecutive patients. BMC Anesthesiol 2022; 22:46. [PMID: 35164679 PMCID: PMC8842968 DOI: 10.1186/s12871-022-01581-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/25/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected. METHODS An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020. RESULTS A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2-negative and -positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p < 0.01 and p = 0.1, respectively). DISCUSSION When comparing SARS-COV-2-positive and -negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.
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Affiliation(s)
- Arthur James
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France.
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214CEDEX 5, Montpellier, France
| | - Thomas Jeanmougin
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Antonia Blanie
- Department of Anesthesiology and Intensive Care Unit, Kremlin Bicêtre, France
| | - Samy Figueiredo
- Department of Anesthesiology and Intensive Care Unit, Kremlin Bicêtre, France
| | - Pierre Goffin
- Department of Anesthesiology and Critical Care, Groupe Santé CHC, MontLegia Hospital, Liège, Belgium
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Medicine, University of Versailles Saint Quentin, Hôpital Foch, Suresnes, France
| | - Elie Kantor
- Department of Anesthesia and Surgical Critical Care, DMU PARABOL, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Flora Cipriani
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Clichy, France
| | - Sébastien Campion
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Mathieu Raux
- Département d'Anesthésie Réanimation, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214CEDEX 5, Montpellier, France
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie Et Réanimation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,GReD; UMR/CNRS6293; INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
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Periappuram J, Thomas J, Philipose S, Vijayan A, Mohammed Y, Padmanabhan M, George A, Wilson J, George G, Abraham J, Sunil GS, Ranganathan B. Postoperative outcomes of cardio-thoracic surgery in post-COVID versus non-COVID patients - Single-center experience. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Moussavi N, Abdorrahim-Kashi E, Azadchehr M, Aminipour M, Talari H, Ghafoor L, Abedzadeh-Kalahroudi M. General surgery admissions, operations, and patient outcomes during the COVID-19 pandemic. ARCHIVES OF TRAUMA RESEARCH 2022. [DOI: 10.4103/atr.atr_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Karna ST, Gouroumourty R, Ahmad Z, Trivedi S, Thaware P, Singh P. Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study. J Postgrad Med 2022; 68:199-206. [PMID: 36255012 PMCID: PMC9841536 DOI: 10.4103/jpgm.jpgm_1197_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background : Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection. Methods and Material We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model. Results Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively). Conclusions SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.
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Affiliation(s)
- ST Karna
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India,Address for correspondence: Dr. Karna ST, E-mail:
| | - R Gouroumourty
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Z Ahmad
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - S Trivedi
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - P Thaware
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - P Singh
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Rajan S, Abraham A, Sasikumar N, Abubaker R, Manoharan K, Kumar L. Incidence and severity of postoperative complications in patients undergoing surgery following COVID-19 infection at a tertiary care center in South India. Anesth Essays Res 2022; 16:268-271. [DOI: 10.4103/aer.aer_134_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
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Marshall SD, Duggan LV. Risk stratification for SARS-CoV-2-related venous thromboembolic events: time for a new paradigm? Anaesthesia 2021; 77:3-6. [PMID: 34738633 PMCID: PMC8652651 DOI: 10.1111/anae.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- S D Marshall
- Department of Anaesthesia and Peri-operative Medicine, Monash University, Melbourne, Australia.,Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - L V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
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Kato H, Asano Y, Arakawa S, Ito M, Kawabe N, Shimura M, Hayashi C, Ochi T, Yasuoka H, Higashiguchi T, Kondo Y, Nagata H, Horiguchi A. Surgery for pancreatic tumors in the midst of COVID-19 pandemic. World J Clin Cases 2021; 9:4460-4466. [PMID: 34222414 PMCID: PMC8223860 DOI: 10.12998/wjcc.v9.i18.4460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/28/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
The spread of the new coronavirus (COVID-19) infection in 2020 has had a significant impact on the treatment of cancer worldwide. During the COVID-19 pandemic, the biggest challenge for pancreatic surgeons is the difficulty in providing oncological care. In this review article, from the standpoint of surgeons, we explain the concept of triaging of patients with pancreatic tumors under the COVID-19 pandemic, and the actual impact of COVID-19 on the treatment of patients with pancreatic tumors. The most vital points in selecting the best therapeutic approach for patients with pancreatic tumors during this pandemic are (1) Oncologists need to tailor the treatment plan based on the COVID-19 phase, tumor malignant potential, and patients' comorbidities; and (2) Optimal treatment for pancreatic cancer should be planned according to the condition of each patient and tumor resectability based on national comprehensive cancer network resectability criteria. To choose the best therapeutic approach for patients with pancreatic tumors during this pandemic, we need to tailor the treatment plan based on elective surgery acuity scale (ESAS). Newly established ESAS for pancreatic tumor and flowchart indicating the treatment strategy of pancreatic cancer, are feasible to overcome this situation.
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Affiliation(s)
- Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Satoshi Arakawa
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Masahiro Ito
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Norihiko Kawabe
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Masahiro Shimura
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Chihiro Hayashi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Takayuki Ochi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Hironobu Yasuoka
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Takahiko Higashiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Yuka Kondo
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Hidetoshi Nagata
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya 454-8509, Japan
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Targeted coronavirus disease 2019 (COVID-19) surveillance for elective procedures: Lessons for resource conservation during a pandemic and beyond. Infect Control Hosp Epidemiol 2021; 43:1293-1295. [PMID: 34039458 PMCID: PMC8185418 DOI: 10.1017/ice.2021.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tateno Y, Harada K, Okamoto F, Katsuragawa H. Elective laparoscopic colectomy in a patient 3 weeks after coronavirus disease 2019 infection: a case report. J Med Case Rep 2021; 15:275. [PMID: 34006322 PMCID: PMC8130803 DOI: 10.1186/s13256-021-02877-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to previous reports, surgery is not recommended until at least 4 weeks after the symptoms of coronavirus disease 2019 resolve. However, strong evidence has not been established regarding the optimal timing and preoperative examination for elective laparoscopic colectomy for colorectal cancer in individuals with a previous coronavirus disease 2019 infection. CASE PRESENTATION A 63-year-old Asian man underwent elective laparoscopic colectomy for sigmoid colon cancer 3 weeks after asymptomatic coronavirus disease 2019. The postoperative course was good, and none of the surgical staff was infected with coronavirus disease 2019. CONCLUSION In this patient infected with coronavirus disease 2019 within 4 weeks of surgery, preoperative venous ultrasound of the lower extremities and a chest computed tomography scan were useful examinations for ensuring a safe surgical procedure for the patient and the staff. Surgery within 4 weeks may be possible with careful selection of cases based on thorough preoperative examination. This report may contribute to the development of a consensus on performing safe elective colectomy for colon cancer in persons previously infected with coronavirus disease 2019.
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Affiliation(s)
- Yuki Tateno
- Department of Surgery, Tama-nambu Regional Hospital, 2-1-2, Nakazawa, Tama, Tokyo, Japan.
| | - Kimito Harada
- Department of Surgery, Tama-nambu Regional Hospital, 2-1-2, Nakazawa, Tama, Tokyo, Japan
| | - Fumiki Okamoto
- Department of Surgery, Tama-nambu Regional Hospital, 2-1-2, Nakazawa, Tama, Tokyo, Japan
| | - Hideo Katsuragawa
- Department of Surgery, Tama-nambu Regional Hospital, 2-1-2, Nakazawa, Tama, Tokyo, Japan
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Reshetnikov MN, Plotkin DV, Zuban ON, Bogorodskaya EM. Emergency surgical care for patients with COVID-19 and tuberculosis coinfection at multispecialty hospital. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The double burden of the novel coronavirus infection and tuberculosis (TB) is a global challenge. The aspects of emergency surgical care for patients with COVID-19 and TB coinfection remain understudied. The aim of this study was to assess treatment outcomes in acute surgical patients with COVID-19 and preexisting TB coinfection. In 2020, our Center delivered surgical care to 465 patients with COVID-19 and preexisting TB; a total of 64 emergency surgeries were performed on 36 (5.6%) patients, of whom 16 had HIV. Thirteen patients (36.1%) were diagnosed with pulmonary TB; 23 patients (63.9%) had disseminated TB. Chest CT scans showed >25% lung involvement in 61.9% of the patients with COVID-19 pneumonia, 25–50% lung involvement in 30.6% of the patients, and 50–75% lung involvement in 5.6% of the patients. By performing abdominal CT, we were able to detect abdominal TB complications, including perforated tuberculous ulcers of the intestine, intestinal obstruction and tuberculous peritonitis, as well as tuberculous spondylitis complicated by psoas abscess. Of all surgical interventions, 28.2% were abdominal, 23.2% were thoracic, 15.6% were surgeries for soft tissue infection, and 32.8% were other types of surgery. Postoperative mortality was 22.2%. We conclude that COVID-19 did not contribute significantly to postoperative mortality among acute surgical patients with TB.
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Affiliation(s)
- MN Reshetnikov
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
| | - DV Plotkin
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
| | - ON Zuban
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
| | - EM Bogorodskaya
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
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