Clinical Characteristics of Emergency Surgery Patients-Infected COVID-19 Pneumonia in Wuhan, China: A Retrospective Cohort Study

Abstract

Background: Almost one million of 2019 novel coronavirus disease (COVID-19) patients were diagnosed in the world wide from December 2019 to now. Thousands of emergency operations were carried out in the interim. However no one focused on the clinical symptom of emergency surgery patients (ESP) with COVID-19 pneumonia. We aimed to investigate clinical symptom and epidemiological features of ESP-infected COVID-19

Methods: Retrospective cohort study of 164 ESP with or without COVID-19 pneumonia in Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 20, 2020. The final date of follow-up was February 5, 2020. The associated clinical, laboratory, epidemiological, demographic, radiological and outcome data were collected and analyzed.

Findings: Of 164 ESP, the median age was 41 years old (interquartile range (IQR), 29-89) and 136 (82.9%) were women. Associated main clinical symptom including fever (93 [56.7%]), dry cough (56 [34.2%]), fatigue (86 [52.4%]), nausea (78 [47.6%]) and dizziness (77 [47%]). Of 54 ESP-infected COVID-19 patients, the median age was 46 (IQR: 25-89) and 45 (83.3%) were women. The pathological clinical symptoms including fever (54 [100%]), fatigue (48 [88.9%]), nausea (52 [96.3%]), dizziness (46 [85.2%]) and dry cough (44 [81.5%]) were investigated; the lymphopenia (0.37×109/L [IQR: 0.23-0.65]) and increased C-reactive protein (24.7×109/L [IQR: 13.57-38]) were observed. The preoperative fever and postoperative fever in ESP with or without COVID-19 pneumonia were analyzed in this study. Of 54 ESP with COVID-19 patients, 15 (27.8%) patients showed preoperative fever, 54 (100%) had the postoperative fever; Of 110 non-COVID-19 of ESP, 5 (4.5%) patients had preoperative fever, 31 (28.2%) patients had the postoperative fever. The fever in ESP with COVID-19 lasted more than 7 days, markedly exceeded the non-COVID-19 patients (lasted about 3 days). Furthermore, 43 health care workers were infected from exposed to ESP with COVID-19 pneumonia.

Interpretation: In our study, the clinical symptoms of ESP-infected COVID-19 displayed marked differences from those reported common COVID-19 pneumonia cases. Additionally, the health care workers were confirmed to expose great risk in ESP with COVID-19 pneumonia. Management guidelines of ESP were described in our paper.

Funding Statement: This study was supported by National Natural Science Foundation of China (NSFC) (81771280).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This research was confirmed by institutional ethics Committee of Zhongnan Hospital of Wuhan University (approval number 2020068).