Elective surgery in the context of the SARS COV- 2 pandemic: reintroducing delayed surgeries

Abstract

The original purpose to cancel scheduled surgeries was to release space and health professionals to provide attention to the high demand of COVID patients, also to minimize the risk of infection of the patients, relatives and health care providers. However, recently it has been known that the mortality and morbidity rate is higher in surgical patients that had COVID during the perioperative period, which confirms that the right decision was to cancel the elective surgeries. Several authors had been shown enough evidence about this matter, like Doglietto, et al (2020) who analysed a retrospective cohort of 123 patients 41 (33.3%) positive to COVID-19 and 82 (66.7%) in the group control. Both groups without significant differences in age, gender, illness and comorbidities. They reported significantly higher mortality in the COVID-19 positive patient group (19.2%) versus (2.4%) the group control [OR: 9.5; 95% IC, 1.77 -96.53]. Pulmonary complications were significantly more frequent in the group of patients positive for COVID-19 versus the group control [OR: 35.63; 95% IC, 9.34 -205.55]. 1 Secondly, in a collaborative international study done by COVIDSurgcollaborative, they examined the data of 1,128 patients in 235 hospitals of 24 countries of Europe, Africa, Asia and Northamerica. The global mortality after 30days was 23.8%. Elective surgery 18.9% and emergency surgery 25.6%. In minor surgery, abdominal wall surgery was 16.3%; in major surgery, orthopedic and cancer it was 26.9%. The mortality rate was significantly higher in men (28.4%) than women (18.2%); in ≻ 70years (33.7%), versus ≺ 70years (13.9%). The most frequent complication was pneumonia (51%) with acute respiratory distress syndrome that required mechanical ventilation. The death cause in 81.7% of the deaths were pulmonary complications. 2 In the last year other authors contributed with more evidence in the same issue. The findings of these studies suggest that the immune system response due to surgical trauma as an aggregate factor in COVID-19 patients can increase the mortality and morbidity in these groups of patients. This can be explained because as the SARS CoV-2 and the surgical trauma induced proinflammatory response and deregulation of the immune system hence both Elective surgery in the context of the SARS COV-2 pandemic: reintroducing delayed surgeries Volume 12 Issue 5 -2021