Raveglia Federico, Scarci Marco, Rimessi Arianna, Orlandi Riccardo, Rebora Paola, Cioffi Ugo, Guttadauro Angelo, Ruffini Enrico, Benvenuti Mauro, Cardillo Giuseppe, Patrini Davide, Vannucci Fernando, Yusuf Nasser, Jindal Pramoj, Cerfolio Robert
Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy.
Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Front Surg. 2022 May 24;9:867252. doi: 10.3389/fsurg.2022.867252. eCollection 2022.
Patients with several thoracic complications induced by SARS-CoV-2 infection may benefit from surgery, but its role in this condition is largely unknown, and many surgeons' advice against any surgical referrals. Our aim is to investigate the efficacy and safety of surgery in COVID-19 patients with thoracic complications requiring surgery.
We designed a multicenter observational study, involving nine thoracic surgery departments, evaluating patients who developed thoracic complications in hospital, surgically managed from March 1, 2020, to May 31, 2021. An overall 30-day mortality was obtained by using the Kaplan-Meier method. Multivariable Cox regression model and logistic models were applied to identify the variables associated with mortality and postoperative complications.
Among 83 patients, 33 (40%) underwent surgery for complicated pneumothorax, 17 (20.5%) for pleural empyema, 13 (15.5%) for hemothorax, 8 (9.5%) for hemoptysis, 5 patients (6%) for lung abscess, 4 (5%) for infected pneumatoceles, and 3 (3.5%) for other causes. Within 30 days of surgery, 60 patients (72%) survived. At multivariable analysis, age (HR 1.05 [95% CI, 1.01, 1.09], = 0.022), pulmonary hypertension (HR 3.98 [95% CI, 1.09, 14.5], = 0.036), renal failure (HR 2.91 [95% CI, 1.19, 7.10], -value 0.019), thoracotomy (HR 4.90 [95% CI, 1.84, 13.1], -value 0.001) and infective affections (HR 0.17 [95% CI, 0.05, 0.58], -value 0.004) were found to be independent prognostic risk factors for 30-day mortality. Age (OR 1.05 [95% CI, 1.01, 1.10], = 0.023) and thoracotomy (OR 3.85 [95% CI, 1.35, 12.0] = 0.014) became significant predictors for 30-day morbidity.
Surgical management of COVID-19-related thoracic complications is affected by high mortality and morbidity rates, but a 72% survival rate still seems to be satisfactory with a rescue intent. Younger patients without pulmonary hypertension, without renal insufficiency and undergoing surgery for infectious complications appear to have a better prognosis.
感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）导致多种胸部并发症的患者可能从手术中获益，但其在这种情况下的作用很大程度上未知，且许多外科医生不建议进行任何手术转诊。我们的目的是研究手术治疗对患有需要手术的胸部并发症的新型冠状病毒肺炎（COVID-19）患者的疗效和安全性。
我们设计了一项多中心观察性研究，涉及9个胸外科，评估2020年3月1日至2021年5月31日期间在医院发生胸部并发症并接受手术治疗的患者。采用Kaplan-Meier法得出总体30天死亡率。应用多变量Cox回归模型和逻辑模型来识别与死亡率和术后并发症相关的变量。
83例患者中，33例（40%）因复杂性气胸接受手术，17例（20.5%）因胸腔积脓接受手术，13例（15.5%）因血胸接受手术，8例（9.5%）因咯血接受手术，5例（6%）因肺脓肿接受手术，4例（5%）因感染性肺气囊接受手术，3例（3.5%）因其他原因接受手术。在术后30天内，60例（72%）患者存活。在多变量分析中，可以发现年龄（风险比[HR]1.05[95%置信区间，1.01，1.09]，P = 0.022）、肺动脉高压（HR 3.98[95%置信区间，1.09，14.5]，P = 0.036）、肾衰竭（HR 2.91[95%置信区间，1.19，7.10]，P值0.019）、开胸手术（HR 4.90[95%置信区间，1.84，13.1]，P值0.001）和感染性疾病（HR 0.17[95%置信区间，0.05，0.58]，P值0.004）是30天死亡率的独立预后危险因素。年龄（比值比[OR]1.05[95%置信区间，1.01，1.10]，P = 0.023）和开胸手术（OR 3.85[95%置信区间，1.35，12.0]，P = 0.014）成为30天发病率的显著预测因素。
COVID-19相关胸部并发症的手术治疗受到高死亡率和发病率的影响，但出于挽救目的，仍有72%的生存率似乎是令人满意的。没有肺动脉高压、没有肾功能不全且因感染性并发症接受手术的年轻患者似乎预后较好。
