Covid-19 patients: additional surgical risk

The comparison between patients with and without Covid-19, exposed in both cases to surgery, revealed a higher incidence of complications and mortality in patients with COVID-19.

A study coordinated by the Directors of Surgery of the University of Brescia and of the ASST-Spedali Civili assessed the first surgical outcomes of Covid-19 patients hospitalized at the Spedali Civili. The results of the study were published in JAMA Surgery, the most prestigious surgical journal in the world.

The study, conducted in the General Hospital, Vascular and Thoracic, Orthopedic and Neurosurgical Units of the Civil Hospitals, included patients who underwent surgery from February 23 to April 1, positive results for tests for Covid-19 before surgery or within a week from the surgery itself.

The study compared Covid-19 patients to patients with the same surgical condition but without Covid-19, with a 1: 2 ratio. Of the 123 patients in the combined cohorts, 30-day mortality was significantly higher for Covid-19 patients than for non-Covid-19 patients (19.5% vs 2.4%). Complications are also significantly higher: lung complications in the head followed by thrombotic complications.

In recent months, several surgeons – neurosurgeons, orthopedists, general surgeons, thoracic surgeons, vascular surgeons – have had to face urgent and sometimes even very complex surgical operations in patients with concomitant Covid-19 infection. Our analysis, although conducted on a limited series of patients – explains prof. Fontanellahighlighted that Covid-19 poses a significant additional surgical risk. It is therefore a risk factor that must always be considered before the intervention, and which is even more important than other factors that are usually taken into consideration, such as age, for example. In the face of a higher incidence of surgical mortality and complications, these data therefore suggest the opportunity, where possible, to postpone surgery in Covid-19 patients “.

Considering the limited data on mortality and complications in Covid-19 patients undergoing surgery, this study paves the way for future research into the risks arising from surgical risk during a pandemic.

Among the authors of the study, together with prof. Fontanella, prof. Stefano Calza and Dr. Marika Vezzoli (biostatisticians), prof. Francesco Doglietto (Neurosurgery), prof. Nazario Portolani (General Surgery), prof. Stefano Bonardelli (Vascular surgery), professors Alessandro Casiraghi and Giuseppe Milano (Orthopedics) and prof. Mauro Benvenuti (Thoracic Surgery). Prof Francesco Castelli (Infectious Diseases) supervised the infectious disease aspects of the work, Prof. Roberto Maroldi for the radiological aspects, Prof Francesco Rasulo (intensive care)

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