Elective surgery during the COVID-19 pandemic may increase complications — small China study

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A study in Wuhan, China’s COVID-19 epicentre suggests that having surgery during the coronavirus incubation period is likely to complicate or prolong your hospital stay. Researchers behind the first study of the effects of surgery on COVID-19 progression said that surgery might accelerate and worsen the disease.

Researchers from Renmin Hospital at Wuhan University and the University of Hong Kong found that 34 surgical patients who were later treated for COVID-19 complications had a 21% mortality rate, versus 2% for nonsurgical COVID-19 patients. Surgical patients also developed symptoms within two days of surgery compared to between five and eight days for the others.

“Surgery may not only cause immediate impairment of immune function but also induce an early systemic inflammatory response,” said lead researcher Shaoqing Lei.

The Times reports that says many hospitals in South Africa have postponed elective surgery, but authorities showed mixed reactions to the Chinese study. Mark van der Heever, spokesperson for the Western Cape Health Department, said the study sample was small and the patients involved had serious cancer procedures and even kidney transplants. “It is not relevant to our population or to any routine elective surgery,” he said.
However, “the department issued a public notice informing clients that … elective surgery will be cancelled”.

Netcare group medical director Anchen Laubscher said the hospital group is postponing all elective surgery, “provided that this will not result in the patient’s outcome or quality of life being significantly altered”.

Abstract
Background: The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China, has spread rapidly worldwide. In the early stage, we encountered a small but meaningful number of patients who were unintentionally scheduled for elective surgeries during the incubation period of COVID-19. We intended to describe their clinical characteristics and outcomes.
Methods: We retrospectively analyzed the clinical data of 34 patients underwent elective surgeries during the incubation period of COVID-19 at Renmin Hospital, Zhongnan Hospital, Tongji Hospital and Central Hospital in Wuhan, from January 1 to February 5, 2020.

Findings: Of the 34 operative patients, the median age was 55 years (IQR, 43–63), and 20 (58·8%) patients were women. All patients developed COVID-19 pneumonia shortly after surgery with abnormal findings on chest computed tomographic scans. Common symptoms included fever (31 [91·2%]), fatigue (25 [73·5%]) and dry cough (18 [52·9%]). 15 (44·1%) patients required admission to intensive care unit (ICU) during disease progression, and 7 patients (20·5%) died after admission to ICU. Compared with non-ICU patients, ICU patients were older, were more likely to have underlying comorbidities, underwent more difficult surgeries, as well as more severe laboratory abnormalities (eg, hyperleukocytemia, lymphopenia). The most common complications in non-survivors included ARDS, shock, arrhythmia and acute cardiac injury.
Interpretation: In this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%.
Funding: National Natural Science Foundation of China.

Authors
Shaoqing Lei, Fang Jiang, Wating Su, Chang Chen, Jingli Chen, Wei Mei, Li-Ying Zhan, Yifan Jia, Liangqing Zhang, Danyong Liu, Zhong-Yuan Xia, Zhengyuan Xia
Full report in The TimeseClinical Medicine abstract

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