Hazardous Postoperative Outcomes of Unexpected COVID‐19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment

Abstract

Background In December 2019, a novel coronavirus was identified as the cause of many pneumonia cases in China and eventually declared as a pandemic as the virus spread globally. Few reports were published on the outcome of surgical procedures in diagnosed COVID-19 patients and even fewer on the surgical outcomes of asymptomatic undiagnosed COVID-19 surgical patients. We aimed to review all published data regarding surgical outcomes of preoperatively asymptomatic untested coronavirus disease 2019 (COVID-19) patients. Methods This report is a review on the perioperative period in COVID-19 patients who were preoperatively asymptomatic and not tested for COVID-19. Searches were conducted in PubMed April 4th, 2020. All publications, of any design, were considered for inclusion. Results Four reports were identified through our literature search, comprising 64 COVID-19 carriers, of them 51 were diagnosed only in the postoperative period. Synthesis of these reports, concerning the postoperative outcomes of patients diagnosed with COVID-19 during the perioperative period, suggested a 14/51 (27.5%) postoperative mortality rate and severe mostly pulmonic complications, as well as medical staff exposure and transmission. Conclusions COVID-19 may have potential hazardous implications on the perioperative course. Our review presents results of unacceptable mortality rate and a high rate of severe complications. These observations warrant further well-designed studies, yet we believe it is time for a global consideration of sampling all asymptomatic patients before surgical treatment.

The tragedy of COVID‐19 in Brazil: 124 maternal deaths and counting

“…Additionally, the rate of cesarean sections is among the highest in the world and questions remain regarding the increased risk of postoperative morbidity and mortality for patients with COVID-19 undergoing surgery. 8 Our findings identified diabetes, cardiovascular disease, and obesity as significant conditions associated with mortality in the obstetric population, similar to the general population ( to 14.6% of all fatal cases, while the remaining 21,4% received non-invasive ventilation only. Failure to adequately report these variables in the surveillance system cannot be ruled out due to its retrospective nature.…”

Preoperative computerized tomography screening for COVID-19 pneumonia in asymptomatic patients: experiences from two centers

“…Patients with COVID-19 disease who undergo surgery suffer a complicated postoperative course [ 5 , 6 ]. Studies have shown that up to 51.2% of these patients had pulmonary complications and among patients who had pulmonary complications after surgery 30-day mortality rate was 38% [ 7 ].…”

Roadmap for Restarting Elective Surgery During/After COVID-19 Pandemic

“…Equally, the Indian Journal of Surgery is bringing out the views of surgeons in its publications Indian Journal of Surgery and has already published special consent form for COVID-19 patients [38]. Most guidelines agree that elective surgery on positive COVID-19 patients should be deferred, until they have been asymptomatic for 72 h and have at least 2 negative COVID-19 tests separated by at least 24 h. Similarly, they also recommend preoperative COVID-19 testing for each patient because if an asymptomatic carrier undergoes surgery or if a perio p e r a t i v e p a ti e n t c o n t a c t s C O V I D -1 9 ; r e l a t i v e immunocompromise after major surgical intervention may worsens the prognosis and overall outcome with unacceptable mortality rate and a high rate of severe complications [14,39]. It is wise and safe to follow the current axiom: "most effective way to prevent viral exposure is to avoid performing nonessential surgical procedures" as this limits the exposure to patients and clinicians, conserves PPEs, and preserves health system capacity [24].…”