Surgery During the COVID-19 Pandemic: Clinical Characteristics and Outcomes of Confirmed Patients

Abstract

Background: The clinical characteristics and outcomes of surgical treatment of patients with COVID-19 remain unclear. This study aimed to determine whether surgery for patients with COVID-19 is safe both for patients and for medical staff.

Methods: Case series of 28 surgical patients with confirmed COVID-19. All cases were treated with surgery. The study was conducted at the Wuhan Union Hospital in Wuhan, China, from February 1, 2020, to April 5, 2020. Clinical characteristics and outcomes are described and compared in different subgroups. Demographics and clinical characteristics of cases, operative duration, routine blood biochemistry, intensive unit care (ICU) after surgery, evidence of COVID-19, treatment and outcome were described.

Findings: 28 patients undergoing emergency surgery. Surgery was performed at 2.5 days (IQR 1.0-10.5) after admission. Median of day from admission to surgery was 2.5 days (IQR 1.0-10.5), while median length of surgery was 120.0 minutes (IQR 60.0-180.0). Among the patients, four underwent general anesthesia and were transferred to the ICU postoperatively, while 21 underwent intraspinal anesthesia. Although the preoperative laboratory results differed significantly between the general anesthesia and intraspinal anesthesia group in terms of white blood cell count, neutrophil count, D-dimer, PT, INR and ALT, there was no significant difference in the postoperative laboratory results between the two groups except for APTT. One patient died and no surgeons were infected with COVID-19 during operation.

Interpretation: In this preliminary uncontrolled case series of 28 patients with COVID-19, surgery was feasible, safe and life-preserving. The limited sample size and study design precludes a definitive statement about the feasibility and safety of performing surgery during a pandemic, and these observations require evaluation at a larger scale.

Funding Statement: This study was supported by the National Science Foundation of China (grant No. 81772345), National Key Research & Development Program of China (grants Nos. 2018YF2001502 and 2018YFB1105705), Wuhan Science and Technology Bureau (grant No. 2017060201010192), the National Health Commission of the People’s Republic of China (grants Nos. ZX-01-018 and ZX-01-C2016153), and the Health Commission of Hubei Province (grant No. WJ2019Z009).

Declaration of Interests: The authors declare no conflict of interest.

Ethics Approval Statement: The study was approved by the ethics committee of Wuhan Union Hospital. Written informed consent was obtained from each patient.