Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, CA.
Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, CA. Electronic address: http://www.twitter.com/MSchumm90.
Surgery. 2022 Jun;171(6):1500-1504. doi: 10.1016/j.surg.2021.12.024. Epub 2021 Dec 30.
Previous studies report high rates of postoperative morbidity and mortality among patients with SARS-CoV-2 (COVID-19). With routine preoperative screening, we are identifying an increasing number of patients with asymptomatic and mild COVID-19. Based on these prior studies, we hypothesized that patients with asymptomatic and mild COVID-19 infections have low perioperative morbidity and mortality. The purpose of this study was to determine the risk of perioperative morbidity and mortality associated with operations performed on patients diagnosed with asymptomatic or mild COVID-19.
A multicenter, retrospective study of patients with asymptomatic/mild SARS-CoV-2 (COVID-19) infection diagnosed within 8 days of surgery from March 2020 to February 2021. The primary outcome was 30-day mortality, and secondary outcomes included pulmonary complications and perioperative morbidity. The Chinese Center for Disease Control and Prevention criteria of COVID severity was used for categorization.
The initial cohort included 53 patients. COVID-19 infection was detected preoperatively in 86.8%. At admission, 90.5% of patients were asymptomatic, 7.5% had mild COVID-19 symptoms, and 1.9% were unknown due to obtundation and later determined to be asymptomatic. Of the 53 cases, 35.8% were general surgical and 18.9% orthopedic; the remaining 54.7% were other surgical subspecialties. Overall mortality was 0%. New COVID-19 symptoms developed in 13.2% of patients postoperatively, with only 11.3% developing postoperative pulmonary complications.
Postoperative morbidity and mortality rates were low among patients with asymptomatic and mild COVID-19. The risks of nonoperative management should be weighed against these operative risks in such patients with surgical indications.
先前的研究报告表明，患有严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2，即 COVID-19）的患者术后发病率和死亡率较高。通过常规术前筛查，我们发现越来越多的 COVID-19 患者无症状且病情较轻。基于这些先前的研究，我们假设无症状和轻症 COVID-19 感染患者的围手术期发病率和死亡率较低。本研究旨在确定诊断为无症状或轻症 COVID-19 感染的患者行手术操作相关的围手术期发病率和死亡率。
这是一项多中心、回顾性研究，纳入了 2020 年 3 月至 2021 年 2 月期间确诊为无症状/轻症 SARS-CoV-2（COVID-19）感染且手术前 8 天内确诊的患者。主要结局为 30 天死亡率，次要结局包括肺部并发症和围手术期发病率。COVID-19 严重程度的中国疾病预防控制中心标准用于分类。
最初的队列纳入了 53 例患者。COVID-19 感染术前检出率为 86.8%。入院时，90.5%的患者无症状，7.5%有轻度 COVID-19 症状，1.9%因意识障碍而无法明确诊断，后来被确定为无症状。53 例患者中，35.8%为普通外科，18.9%为骨科；其余 54.7%为其他外科亚专科。总体死亡率为 0%。术后新发 COVID-19 症状的患者占 13.2%，仅有 11.3%的患者发生术后肺部并发症。
无症状和轻症 COVID-19 患者的术后发病率和死亡率较低。对于有手术适应证的此类患者，应权衡非手术治疗的风险与手术风险。
