PMC:7543325 / 9802-16717 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7543325","sourcedb":"PMC","sourceid":"7543325","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7543325","text":"RESULTS\nSurgical activity during the pandemic was dramatically reduced compared to that during the months before the pandemic (Fig. 2). The number of elective surgical procedures during March was reduced to 20, 47% fewer than the previous month. No lung transplant was performed during the COVID-19 pandemic.\nFigure 2: Elective surgical activity before and during the pandemic. COVID-19: coronavirus disease 2019. In total, 35 patients were referred for surgical procedures during the COVID-19 pandemic from 1 March to 24 April. One patient admitted for a lung cancer staging mediastinoscopy started to show fever and respiratory symptoms compatible with COVID-19 h before the operation. A diagnostic PCR was performed for SARS-CoV-2; the test results were positive; the surgical intervention was cancelled. The patient died of SARS-CoV-2 pneumonia.\nOf the 34 patients who finally underwent thoracic surgery, 12 were women and 22 were men; the average age was 60 years. A majority (25) were patients with cancer. Among the comorbidities, the most frequent was hypertension (11) followed by dyslipidaemia (10), chronic obstructive pulmonary disease (5), diabetes (5), kidney failure (2) and cardiovascular disease (2).\nThe most frequent operations, described in Table 3, were anatomical lobectomy (11) and wedge segmentectomy (8); followed by mediastinoscopy (4), bullectomy (3), pleural biopsy (2), lung biopsy (2), extrapleural pneumonectomy (1), anatomical sublobar resection (1), and 2 emergency thoracotomies, 1 for control of thoracic trauma damage and another due to mediastinitis. The average length of stay was 4.72 days. The patients had the following postoperative complications: 1 patient had non-surgical bleeding; 1, acute renal failure; 1, pneumothorax; and 1, atrial fibrillation, all of which were resolved favourably. The patient who had thoracic trauma presented with fever and pulmonary infiltrates 7 days after the operation and was diagnosed with bilateral SARS-CoV-2 pneumonia. Two patients died within 30 days after surgery: 1 was diagnosed with COVID-19 and the other died of advanced cancer.\nTable 3: Outcomes of postoperative patients during the COVID-19 pandemic\nProcedure N (%) Period Hospitalization (days) Postoperative complicationsa Deathsb\nPrescreening period Post-screening period\n1–19 March 20 March– 5 April Diagnostic PCR COVID-19 6–24 April Screening PCR COVID-19 Diagnostic PCR COVID-19 Yes Type T COVID+\nTotal % 34 22 (65%) 2 (6%) (−) (+) 10 (29%) All negative 4.72 4 2 1\nElective surgery Mediastinoscopy 4 (12) 2 0 2 2 1 0 0 0\nPleural biopsy 2 (6) 1 0 1 1 5.5 1 Bleeding 1 0\nLung biopsy 2 (6) 2 0 0 0 4 0 0 0\nWedge segmentectomy 8 (24) 7 0 1 (9 days)c 1 1 3.9 1 AKI 1 1\nAnatomical sublobar resection 1 (3) 1 0 0 0 None 3 0 0 0\nAnatomical lobectomy 11 (32) 6 0 5 5 5.3 1 AF 0 0\nExtrapleural pneumonectomy 1 (3) 1 0 0 0 8 0 0 0\nUrgent surgeryd Bullectomy 3 (9) 1 2 1 0 0 8.3 0 0 0\nEmergency surgerye Thoracic trauma damage control 1 (3) 1 0 1 (7 days)c 0 0 (−)f 1 Pneumonia 0 0\nMediastinitis 1 (3) 0 0 1 1 (−)f 0 0 0\na Early postoperative complications during hospitalization.\nb Mortality within 30 days after surgery was divided in T (total mortality) and COVID+ (mortality due to COVID-19).\nc Days after surgery PCR SARS-CoV-2 test results were positive.\nd Urgent surgery: not life-threatening.\ne Emergency surgery: life-threatening.\nf Still hospitalized at the writing of this article.\nAF: atrial fibrillation; AKI: acute kidney injury; COVID-19: coronavirus disease 2019; PCR: polymerase chain reaction; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2. On 1 March, the first patient with COVID-19 was diagnosed at 12 de Octubre University Hospital. Elective surgical interventions were carried out regularly in the thoracic surgery department until 19 March: a total of 19 elective procedures, 1 urgent procedure and 1 emergency procedure. During this period, 2 patients developed symptoms of COVID-19 and had positive PCR test results. Diagnostic imaging was performed (1 chest CT and 1 chest X-ray); the results of both imaging texts were compatible with SARS-CoV-2 pneumonia [13, 14].\nGiven the severity of the pandemic at that time and the limited resources, our centre was forced to delay several surgical procedures. Starting 20 March, we only performed urgent or emergency surgical procedures. Only 2 procedures were carried out for pneumothorax with persistent air leak. One started with respiratory symptoms but the results of the PCR test were negative.\nStarting 6 April, we added non-delayed oncological surgical procedures according to previously described criteria [7]. In total, between 6 and 24 April, only asymptomatic patients with negative PCR test results who met tumour resectability criteria, completed quarantine, and had chest CT results that were not suspicious for COVID-19 were operated on. We performed 9 electives surgical procedures and 1 emergency thoracotomy procedure for mediastinitis drainage. More than 60% of the elective operations were lung resections in patients diagnosed with carcinoma. During this last period, all patients underwent the COVID-19 screening protocol; no SARS-CoV-2 infections were detected before the operation and neither of them, as of this writing, has developed the disease.\nIn total, 2 of the 34 patients (5.88%) who underwent surgery during the COVID-19 pandemic were diagnosed with COVID-19. One of the 2 had thoracic trauma with multiple rib fractures and right haemothorax and required an emergency thoracotomy for damage control on 15 March. On the seventh postoperative day, the patient started showing symptoms of fever and pulmonary infiltrates on a CT scan, so he was tested with SARS-CoV-2 PCR, the results of which were positive; he was diagnosed with bilateral SARS-CoV-2 pneumonia. The course of the patient’s disease was difficult: he required a tracheostomy. As of this writing, the patient has been discharged from the intensive care unit but is still hospitalized. The results of the latest test for SARS-CoV-2 were negative; he has been decannulated, and he does not require oxygen therapy.\nThe second patient was a 79-year-old man who underwent a wedge segmentectomy of the left upper lobe on 16 March. He had a history of a right upper lobectomy, radical nephrectomy for renal carcinoma, aortic aneurysm, atrial fibrillation, hypertension and ischaemic heart disease, classified as American Society of Anesthesiologists classification IV. The patient was discharged after the operation but returned to the emergency room on the 9th postoperative day with respiratory symptoms. He was diagnosed with bilateral COVID-19 pneumonia. 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