Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain.
Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
World J Surg. 2023 Dec;47(12):2958-2965. doi: 10.1007/s00268-023-07222-y. Epub 2023 Oct 24.
The reported high surgical morbidity and mortality in patients with SARS-CoV-2 prompted preoperative screening and modification of surgical protocols. Although vaccination and treatment of COVID-19 have resulted in lower hospitalization rates and infection severity, publications on postoperative results have not been updated. The aim of the study was to analyze the outcomes of patients undergoing surgery in two periods with high incidence of SARS-CoV-2 infection, before and after vaccination.
This is a prospective cohort study of patients undergoing surgery in two periods: March-June 2020 (Group2020) and December 2021-February 2022 (Group2022) (after massive vaccination).
In total, 618 patients who underwent surgery were included in the analysis (Group2020: 343 vs. Group2022: 275). Significantly more oncological procedures were performed in Group2020, and there were no differences in postoperative complications. Nosocomial SARS-CoV-2 infection occurred in 4 patients in Group2020 and 1 patient in Group2022. In Group 2022, 70 patients (25.4%) had COVID-19 prior to surgery, and 68 (97.1%) were vaccinated. Comparative analysis between patients with past COVID-19 and those without showed no difference in postoperative morbidity and mortality. According to the time elapsed between SARS-CoV-2 infection and surgery (≤ 7 or > 7 weeks), comparative analysis showed no significant differences.
The establishment of preoperative screening protocols for SARS-CoV-2 infection results in a low incidence of nosocomial infection and optimal postoperative outcomes. Preoperative SARS-CoV-2 infection in vaccinated patients was not associated with increased postoperative complications, even in shorter periods after infection. In surgical patients, individualized preoperative evaluation after SARS-CoV-2 infection may be more important than strict time limitation.
据报道，SARS-CoV-2 患者的手术发病率和死亡率较高，这促使人们对手术前进行筛查并修改手术方案。尽管 COVID-19 的疫苗接种和治疗导致住院率和感染严重程度降低，但有关术后结果的出版物尚未更新。本研究的目的是分析在 SARS-CoV-2 感染高发期（接种疫苗前后）进行手术的患者的结局。
这是一项前瞻性队列研究，纳入了两个时期接受手术的患者：2020 年 3 月至 6 月（2020 组）和 2021 年 12 月至 2022 年 2 月（2022 组）（大规模接种疫苗后）。
共有 618 例患者纳入分析（2020 组 343 例，2022 组 275 例）。2020 组中明显更多地进行了肿瘤手术，两组术后并发症无差异。2020 组有 4 例患者发生院内 SARS-CoV-2 感染，2022 组有 1 例。2022 组中有 70 例（25.4%）患者术前有过 COVID-19，且 68 例（97.1%）患者已接种疫苗。对有过 COVID-19 病史的患者和无 COVID-19 病史的患者进行比较分析，发现术后发病率和死亡率无差异。根据 SARS-CoV-2 感染与手术之间的时间间隔（≤7 或>7 周）进行比较分析，未发现显著差异。
建立 SARS-CoV-2 感染的术前筛查方案可降低院内感染发生率并获得良好的术后结局。在接种疫苗的患者中，术前 SARS-CoV-2 感染与术后并发症增加无关，即使是在感染后较短时间内。对于接受过 SARS-CoV-2 感染的手术患者，个体化的术前评估可能比严格的时间限制更重要。
