Cuypers Quinten, Vandebergh Vincent, Stessel Bjorn, Callebaut Ina, Depauw Ilse, Saldien Vera, Vrancken Dirk
Department of Anesthesiology and Pain Medicine, Jessa Ziekenhuis Vzw, Hasselt, Belgium.
Emergency Department, UZ Leuven, Leuven, Belgium.
Anesth Pain Med. 2022 Nov 12;12(5):e127356. doi: 10.5812/aapm-127356. eCollection 2022 Oct.
Current guidelines from the American Society of Anesthesiologists recommend postponing elective surgery on COVID-19-positive patients for a minimum of four to twelve weeks. However, literature focusing on the outcomes of COVID-19-positive patients undergoing surgery is scarce. In this case series, the outcome of asymptomatic COVID-19 patients undergoing acute or semi-urgent surgery was evaluated.
A case series of four patients between 32 and 82 years old with a confirmed SARS-CoV-2 infection undergoing acute or semi-urgent surgery was presented here. All four patients were asymptomatic for COVID-19, developing severe respiratory failure following endo CABG, caesarian section, a thyroidectomy, or abdominal surgery. ICU admission, together with invasive ventilation, was necessary for all patients. Two patients required venovenous extracorporeal membrane oxygenation treatment. A mortality of 50% was observed.
In conclusion, the present case series suggests that elective surgery in asymptomatic SARS-CoV-2 infected patients might elicit an exacerbated COVID-19 disease course. This study endorses the current international guidelines recommending postponing elective surgery for SARS-CoV-2-positive patients for seven weeks, depending on the severity of the surgery and perioperative morbidities, to minimize postoperative mortality.
美国麻醉医师协会当前的指南建议，对于新冠病毒检测呈阳性的患者，应将择期手术推迟至少四至十二周。然而，关注新冠病毒检测呈阳性患者手术结局的文献却很匮乏。在本病例系列中，对无症状新冠病毒患者进行急性或半紧急手术的结局进行了评估。
本文介绍了一个病例系列，包含四名年龄在32至82岁之间、确诊感染严重急性呼吸综合征冠状病毒2并接受急性或半紧急手术的患者。所有四名患者感染新冠病毒后均无症状，但在接受冠状动脉搭桥术、剖宫产、甲状腺切除术或腹部手术后均出现了严重呼吸衰竭。所有患者均需要入住重症监护病房并进行有创通气。两名患者需要静脉-静脉体外膜肺氧合治疗。观察到的死亡率为50%。
总之，本病例系列表明，对无症状感染严重急性呼吸综合征冠状病毒2的患者进行择期手术可能会导致新冠病毒病程加重。本研究支持当前的国际指南，即根据手术的严重程度和围手术期发病率，建议将新冠病毒检测呈阳性患者的择期手术推迟七周，以尽量降低术后死亡率。
